Mehmet Ali NARSAT, Sedat GÜLTEN, Eren YILDIZ

Utility of immature granulocyte count in differentiating between pyelonephritis and cystitis in pediatric patients

Aims: Immature granulocyte (IG) is an easily accessible and inexpensive test that can be measured in hemogram parameters without additional analysis. It can be used in differentiation because of its practical applicability. This study aimed to investigate the role of IG count and inflammation-related complete blood count (CBC) parameters in differentiating between cystitis (CYS) and pyelonephritis (PYL) in pediatric patients. Methods: This retrospective cross-sectional study analyzed data from 79 pediatric patients (40 with PYL and 39 with CYS) who presented at a hospital pediatric outpatient clinic between January 2020 - February 2021. In addition to clinical symptoms and signs, laboratory and urinalysis results were evaluated. Laboratory analyses focused on IG count, IG percentage, and all hemogram parameters. Results: No significant demographic differences were observed between the PYL and CYS groups (p>0.05). IG counts, and C-reactive protein levels significantly differed between the two conditions (p<0.001). IG count was identified as an independent factor for distinguishing between PYL and CYS, with a sensitivity of 89.5% and a specificity of 92.6% (p<0.0001). Conclusion: The IG count, an easily accessible and cost-effective test, is valuable in differentiating PYL and CYS (p<0.001). This finding holds promising implications for the prompt and accurate diagnosis of these conditions in pediatric patients.

Keywords:

Immature granulocyte C-reactive protein, pyelonephritis, cystitis,

PDF

___

Tullus K, Shaikh N. Urinary tract infections in children. Lancet. 2020;395(10237):1659-1668.
Albarrak M, Alzomor O, Almaghrabi R, et al. Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med. 2021;8(2):57-67.
Nyandwi J, Manirakiza S, Ndirahisha E, et al. Frequency of uropathogens and antimicrobial susceptibility in childhood urinary tract infection at Kamenge University Hospital, Bujumbura, Burundi. East Afr Health Res J. 2017;1(1):47-52.
Meena J, Kumar J. Adjuvant corticosteroids for prevention of kidney scarring in children with acute pyelonephritis: a systematic review and meta-analysis. Arch Dis Child. 2021;106(11):1081-1086.
Pleniceanu O, Twig G, Tzur D, et al. Acute pyelonephritis in children and the risk of end-stage kidney disease. J Nephrol. 2021;34(5):1757-1765.
Ruiz-Rosado JD, Robledo-Avila F, Cortado H, et al. Neutrophil-macrophage imbalance drives the development of renal scarring during experimental pyelonephritis. J Am Soc Nephrol. 2021;32(1):69-85.
Yang SS, Tsai JD, Kanematsu A, Han CH. Asian guidelines for urinary tract infection in children. J Infect Chemother. 2021;27(11):1543-1554.
Lee J, Kwon DG, Park SJ, Pai KS. Discordant findings on dimercaptosuccinic acid scintigraphy in children with multi-detector row computed tomography-proven acute pyelonephritis. Korean J Pediatr. 2011;54(5):212-218.
Lee JW, Kim SH, Park SJ, et al. The value of delta neutrophil index in young infants with febrile urinary tract infection. Sci Rep. 2017;7:41265.
Mattoo TK, Skoog SJ, Gravens-Mueller L, et al. Interobserver variability for interpretation of DMSA scans in the RIVUR trial. J Pediatr Urol. 2017;13(6):616.e611-616.e616.
Shaikh KJ, Osio VA, Leeflang MM, Shaikh N. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 2020;9(9):Cd009185.
Esteghamati M, Ghasemi K, Zahedi M, Zoghi G, Dadvand H. D-dimer Versus Procalcitonin for the Diagnosis of Pediatric UTI and Prediction of Renal Parenchymal Involvement. Iran J Kidney Dis. 2021;15(5):336-343.
Mazaheri M. Serum Interleukin-6 and Interleukin-8 are Sensitive Markers for Early Detection of Pyelonephritis and Its Prevention to Progression to Chronic Kidney Disease. Int J Prev Med. 2021;12:2.
Yoon SH, Shin H, Lee KH, et al. Predictive factors for bacteremia in febrile infants with urinary tract infection. Sci Rep. 2020;10(1):4469.
McMaster P, Park DY, Shann F, et al. Procalcitonin versus C-reactive protein and immature-to-total neutrophil ratio as markers of infection after cardiopulmonary bypass in children. Pediatric Critical Care Med. 2009;10(2)
Jung SJ, Lee JH. Prediction of cortical defect using c-reactive protein and urine sodium to potassium ratio in infants with febrile urinary tract infection. Yonsei Med J. 2016;57(1):103-110.
Biggi A, Dardanelli L, Pomero G, et al. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatric Nephrology. 2001;16(9):733-738.
Kotoula A, Gardikis S, Tsalkidis A, et al. Comparative efficacies of procalcitonin and conventional inflammatory markers for prediction of renal parenchymal inflammation in pediatric first urinary tract infection. Urology. 2009;73(4):782-786.
Güven AG, Kazdal HZ, Koyun M, et al. Accurate diagnosis of acute pyelonephritis: How helpful is procalcitonin? Nuclear Med Commun. 2006;27(9):715-721.
Incir S. The Role of Immature Granulocytes and Inflammatory Hemogram Indices in the Inflammation. Int J Med Biochem. 2020;
Nierhaus A, Klatte S, Linssen J, et al. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis--a prospective, observational study. BMC Immunol. 2013;14:8-8.
Henriot I, Launay E, Boubaya M, et al. New parameters on the hematology analyzer XN-10 (SysmexTM) allow to distinguish childhood bacterial and viral infections. Int J Lab Hematol. 2016;39(1):14-20.
incir s. Can Immature Granulocyte Count and Hemogram Indices be Good Predictors of Urinary Tract Infections in Children? Int J Med Biochem. 2021;
Yoon SH, Shin H, Lee KH, et al. Predictive factors for bacteremia in febrile infants with urinary tract infection. Scientific Reports. 2020;10(1):4469-4469.
Lee JW, Kim SH, Park SJ, et al. The value of delta neutrophil index in young infants with febrile urinary tract infection. Scientific Reports. 2017;7:41265-41265.
Park H-J, Ha Y-J, Pyo J-Y, Park Y-B, Lee S-K, Lee S-W. Delta neutrophil index as an early marker for differential diagnosis of adult-onset Still's disease and sepsis. Yonsei Med J. 2014;55(3):753-759.