The combination of urinary IL - 6 and renal biometry as useful diagnostic tools to differentiate acute pyelonephritis from lower urinary tract infection

ABSTRACT Objective: To evaluate the role of renal ultrasound (RUS) and urinary IL-6 in the differentiation between acute pyelonephritis (APN) and lower urinary tract infection (LUTI). Patients and methods: This prospective study was carried out at the Pediatric and urology outpatient and inpatient departments of Cairo University Children's Hospital as well as October 6 University Hospital and it included 155 children between one month and fourteen years old with positive culture UTI. Patients were categorized into APN and LUTI based on their clinical features and laboratory parameters. Thirty healthy children, age and sex matched constituted the control group. Children with positive urine cultures were treated with appropriate antibiotics. Before treatment, urinary IL-6 was measured by enzyme immunoassay technique (ELISA), and renal ultrasound (RUS) was done. CRP (C-reactive protein), IL-6 and RUS were repeated on the 14th day of antibiotic treatment to evaluate the changes in their levels in response to treatment. Results: UIL-6 levels were more significantly higher in patients with APN than in patients with LUTI (24.3±19.3pg/mL for APN vs. 7.3±2.7pg/mL in LUTI (95% CI: 2.6-27.4; p<0.01). Similarly, serum CRP was more significantly higher in patients with APN than in children with LUTI (19.7±9.1μg/mL vs. 5.5±2.3μg/mL (p<0.01). IL-6 levels >20pg/mL and serum CRP >20μg/mL were highly reliable markers of APN. Mean renal volume and mean volume difference between the two kidneys in the APN group were more than that of the LUTI and control groups (P<0.001). Renal volume between 120-130% of normal was the best for differentiating APN from LUTI. Conclusions: RUS and urinary IL-6 levels have a highly dependable role in the differentiation between APN and LUTI especially in places where other investigations are not available and/ or affordable.

Urinary interleukin 6 and 8 concentrations in children with acute pyelonephritis, before and after treatment

Urinary tract infections [UTI] are common cause of morbidity and mortality especially in young children around the world. Pyelonephritis can lead to scar formation, and subsequent hypertension and renal failure. Interleukins play a major role in renal scar formation following febrile pyelonephritis. The aim of this study was to investigate the level of urinary interleukin-6 [UIL-6] and UIL-8 concentrations during the acute phase of pyelonephritis and after two kinds of treatment. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with acute pyelonephritis who were treated with Ceftriaxone plus steroids [case group] and in 20 patients treated with antibiotic alone [control group]. Cases and controls were age and sex matched. Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 hours after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated. The differences between the cytokine/creatinine ratios in the initial urine samples and the follow-up samples were significant in the case group [p < 0.001], but not for the controls. In addition, combined antibiotic and steroids significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone [p < 0.05]. We conclude that steroids combined with antibiothics significantly decrease UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This result can suggest that the clinical use of corticosteroids may prevent scar formation following pyelonephritis

Serum and urinary interleukin-6 and serum interleukin-1 receptor antagonist in renal involvement in systemic lupus erythematosus

This study included 45 systemic lupus erythematosus [SLE] patients and 15 age and sex matched controls. All patients [3 males and 42 females] met the revised ACR criteria for the diagnosis of SLE, their ages ranged from 11-50 years. Each patient was subjected to complete history, clinical examination and laboratory investigations including complete blood count, complete urine analysis, 24 hours total urinary protein excretion, erythrocyte sedimentation rate [ESR], Coombs test, blood urea, creatinine clearance, anti-nuclear antibodies [ANA], anti- dsDNA IgG antibodies, C-reactive protein [CRP], serum and urinary interleukin-6 [sIL-6 and uIL-6], serum interleukin-1 receptor antagonist [sIL-1 ra], complement [C3 and C4] and renal biopsy. SLE disease activity was measured by systemic lupus activity measure [SLAM]. SLE patients were classified into two groups [renal and non- renal group]; in addition, the renal group was subdivided into two subgroups [active lupus nephritis [ALN] and inactive lupus nephritis [EN]]. The study concluded that urinary IL-6 may reveal the pathological changes more sensitively. Adding the measurement of uIL-6 level to the conventional prognostic indices of lupus nephritis may improve the ability to accurately predict the outcome in patients with lupus nephritis. Low serum concentration of IL-1 ra, low serum level of both CRP and circulating C3 in renal group appear to be markers of kidney involvement