Proinflammatory Cytokines and Leptin Are Increased in Serum of Prepubertal Obese Children

It has not yet been shown in prepubertal children how cytokines, leptin, and body mass, as well as parameters of obesity are interrelated. The aim of this study was to explore the relation between circulating levels of some cytokines with leptin and body mass index. A case control study was carried out in obese children of both sexes. An obese group was carried out with 63 school prepubertal children and a control group comprised the same number of nonobese children paired by age and by sex. Mean serum leptin concentration was significantly higher in the obese children at 19.9 ± 7.4 ng/mL, than the control group (7.9 ± 5.1 ng/mL). Serum IL-1β, IL-6, and TNF-α levels were also significantly higher in the obese group than controls (33.0 ± 8.9, 45.2 ± 11.8, and 9.2 ± 2.3 pg/mL, versus 3.6 ± 1.0, 13.1 ± 3.9, and 3.9 ± 1.0 pg/mL, resp). In controversy, serum IL-2 level was diminished in the obese group as 0.4 ± 0.1 versus 0.9 ± 0.1 U/L. Obesity may be a low-grade systemic inflammatory disease. Obese prepubertal children have elevated serum levels of IL-1β, IL-6, and TNF-α which are known as markers of inflammation

Prediction of High-Grade Vesicoureteral Reflux after Pediatric Urinary Tract Infection: External Validation Study of Procalcitonin-Based Decision Rule

BACKGROUND: Predicting vesico-ureteral reflux (VUR) 653 at the time of the first urinary tract infection (UTI) would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level 650.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level 650.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility. STUDY DESIGN: A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated. RESULTS: The study included 413 patients (157 boys, VUR 653 in 11%) from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52), not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76), leading to a difference of 20% (95%CI, 17-36). In all, 16 (34%) patients among the 47 with VUR 653 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT); the validation set samples may have been collected earlier than for the derivation one. CONCLUSIONS: The rule built to predict VUR 653 had a stable specificity (ie. 46%), but a decreased sensitivity (ie. 64%) because of the time variability of PCT measurement. Some refinement may be warranted

Association of procalcitonin with acute pyelonephritis and renal scars in pediatric UTI.

Procalcitonin was a more robust predictor compared with C-reactive protein or white blood cell count for selectively identifying children who had APN during the early stages of UTI, as well as those with late scarring

Procalcitonin is a predictor for high-grade vesicoureteral reflux in children: Meta-analysis of individual patient data

Objective: To assess the predictive value of procalcitonin, a serum inflammatory marker, in the identification of children with first urinary tract infection (UTI) who might have high-grade (≥3) vesicoureteral reflux (VUR). Study design: We conducted a meta-analysis of individual data, including all series of children aged 1 month to 4 years with a first UTI, a procalcitonin (PCT) level measurement, cystograms, and an early dimercaptosuccinic acid scan. Results: Of the 152 relevant identified articles, 12 studies representing 526 patients (10% with VUR ≥3) were included. PCT level was associated with VUR ≥3 as a continuous (P =.001), and as a binary variable, with a 0.5 ng/mL preferred threshold (adjusted OR, 2.5; 95% CI, 1.1 to 5.4). The sensitivity of PCT ≥0.5 ng/mL was 83% (95% CI, 71 to 91) with 43% specificity rate (95% CI, 38 to 47). In the subgroup of children with a positive results on dimercaptosuccinic acid scan, PCT ≥0.5 ng/mL was also associated with high-grade VUR (adjusted OR, 4.8; 95% CI, 1.3 to 17.6). Conclusions: We confirmed that PCT is a sensitive and validated predictor strongly associated with VUR ≥3, regardless of the presence of early renal parenchymal involvement in children with a first UTI. © 2011 Mosby Inc. All rights reserved

Pediatric urolithiasis: an 8-year experience of single centre

Objective The objective was to investigate the clinical features and metabolic and anatomic risk factors for kidney stone formation in our patient group

Distribution of Procalcitonin values according to the presence of high-grade VUR and the presence of Ureteral dilation on renal ultrasonography.

<p>The horizontal lines are the dichotomization threshold in each group.</p

Distribution of Procalcitonin values according to the presence of high-grade VUR and the presence of Ureteral dilation on renal ultrasonography.

<p>Distribution of Procalcitonin values according to the presence of high-grade VUR and the presence of Ureteral dilation on renal ultrasonography.</p

Comparison of the characteristics of the derivation and validation populations.

<p>Values are expressed as n (%) for binary variables (gender, All grade and high-grade VUR, Ureteral dilation), and as: mean (±Standard deviation); median (inter-quartile range) for continuous variables (age, CPR, PCT).</p><p>*Data in the column come from the previously published derivation of the decision rule <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029556#pone.0029556-Jodal2" target="_blank">[34]</a>.</p><p>**Binary variables were compared using a χ² test, and continuous variables were compared using the non-parametric Mann-Whitney test.</p><p>Abbreviations: CRP, C-reactive protein; PCT, Procalcitonin; U dilation, Ureteral dilation; VUR, Vesico-ureteral reflux.</p