Introduction: The mean platelet volume (MPV) is a determinant of inflammation. The aim of the present study was to investigate the MPV levels in children with pyelonephritis and to evaluate the possible relationship between MPV and febrile UTI.Materials and Methods: In this prospective observational study, 82 patients with Pyelonephritis (group A) and 82 patients with viral gastroenteritis (group B) were enrolled from 20 Jun 2013 through 15 Jan 2014. The patients were divided into two groups according to the presence of pyelonephritis and viral gastroenteritis. The pyelonephritis group (A) included 82 patients and the acute gastroenteritis group (B) included 82 patients. Complete blood count (CBC) parameters were measured at admission. Routine biochemical tests were performed. Groups were compared according to different parameters.Results: A total of 164 patients were included from inpatients of Amir-Kabir Hospital. The mean platelet volume was lower in group (A) and it was associated with acute pyelonephritis (P =0 .003). The MPV (6.03 ± 0.26 fl vs. 9.06 ± 0.73 fl) was significantly lower in group (A), the platelet count (219.88-± 52.31vs. 184.09 ± 52.21) was significantly higher in group (A), and the WBC count (13.01± 3.43 vs. 8.30 ± 1.13) was significantly higher in group (A).Conclusions: MPV levels were significantly lower in children with pyelonephritis compared with controls. MPV can be used as a negative acute phase reactant in children with febrile UTI.Keywords: Child; Pyelonephritis; Mean Platelet Volume; Urinary tract infection

Eghbali, Aziz

Kahbazi, Manijeh

Pakniyat, Abdolghader

Rafiei, Mohammad

Taherahmadi, Hassan

Yousefichaijan, Parsa

English

Journals Portal, Shahid Beheshti University of Medical Sciences

Mean Platelet Volume in Pyelonephritis - Yousefichaijan P et alJournal of Pediatric Nephrology | Volume 4 | Number 2| 2016 56Research ArticleJ Ped. Nephrology 2016;4(2):56-59http://journals.sbmu.ac.ir/jpnDOI: The Mean Platelet Volume in children with PyelonephritisHow to Cite This Article: Yousefichaijan P, Kahbazi M, Egbali A, Taherahmadi H, Rafiei M, Pakniyat A. The Mean Platelet Volume in children with pyelonepkritis J Ped. Nephrology 2016;4(2):56-59.Parsa Yousefichaijan,ÄManijeh Kahbazi,2Aziz Eghbali,3Hassan Taherahmadi,4Mohammad Rafiei,5Abdolghader Pakniyat6*1 Associate Professor of Pediatric Nephrology,Amir Kabir Hospital, Department of PediatricNephrology, School of Medicine, ArakUniversityof Medical Sciences, Arak, Iran.2 Associate Professor of Pediatric InfectiousDisease. Amir Kabir Hospital, Department ofPediatric Nephrology, School of Medicine, ArakUniversity of Medical Sciences, Arak, Iran.3 Assistant Professor of Pediatric Oncology-Hematology, Amir Kabir Hospital, School ofMedicine, Arak University of Medical Sciences,Arak, Iran. 4 Assistant Professor of Pediatrics. Amir KabirHospital, Department of Pediatric Nephrology, School of Medicine, Arak University of MedicalSciences, Arak, Iran.5 Associate Professor of Biostatistics, School ofMedicine, Arak University of Medical Sciences,Arak, Iran.6 Student Research Committee, Emergency Medicine, Arak University of Medical Sciences, Arak/Iran.*Corresponding AuthorAbdolghader Pakniyat, MD. Students Research Committee, School of Medicine, Arak University of Medical Sciences, Arak, Iran.Telfax: +9808633133193Email: abdolghader.pakniyat@gmail.comIntroduction: The mean platelet volume (MPV) is a determinant of inflammation. The aim of the present study was to investigate the MPV levels in children with pyelonephritis and to evaluate the possible relationship between MPV and febrile UTI.Materials and Methods: In this prospective observational study, 82 patients with Pyelonephritis (group A) and 82 patients with viral gastroenteritis (group B) were enrolled from 20 Jun 2013 through 15 Jan 2014. The patients were divided into two groups according to the presence of pyelonephritis and viral gastroenteritis. The pyelonephritis group (A) included 82 patients and the acute gastroenteritis group (B) included 82 patients. Complete blood count (CBC) parameters were measured at admission. Routine biochemical tests were performed. Groups were compared according to different parameters.Results: A total of 164 patients were included from inpatients of Amir-Kabir Hospital. The mean platelet volume was lower in group (A) and it was associated with acute pyelonephritis (P =0 .003). The MPV (6.03 ± 0.26  l vs. 9.06 ± 0.73  l) was signi icantly lower in group (A), the platelet count (219.88-± 52.31vs. 184.09 ± 52.21) was significantly higher in group (A), and the WBC count (13.01± 3.43 vs. 8.30 ± 1.13) was significantly higher in group (A).Conclusions: MPV levels were significantly lower in children with pyelonephritis compared with controls. MPV can be used as a negative acute phase reactant in children with febrile UTI.Keywords: Child; Pyelonephritis; Mean Platelet Volume; Urinary tract infection.Received: Jan-2016Revised: Feb-2016Accepted: Feb-2016Running Title: Mean Platelet Volume in PyelonephritisIntroduction Urinary tract infections (UTIs) occur in 1-3% of girls and 1% of boys. The diagnosis of UTI requires a culture of the urine. Urine samples for urinalysis should be examined promptly or refrigerated until cultured [1-3]. Urine obtained Mean Platelet Volume in Pyelonephritis - Yousefichaijan P et alJournal of Pediatric Nephrology | Volume 4 | Number 2| 2016 57by the midstream, clean-catch technique (for older children and adolescents) is considered significant with bacterial growth of a single organism of more than 100,000 colony-forming units (CFU)/mL, and has a 95% positive correlation with a positive culture by suprapubic aspiration. Perineal bags for urine collection are prone to contamination and are not recommended for urine collection for culture [4, 5]. Urinary dipstick tests that combine both the leukocyte esterase and nitrite have a sensitivity of 88% and a speci icity of 93% for detecting a UTI [6,7,8]. The presence of even scant bacteria has a correlation of 82% with a positive culture by suprapubic aspiration [9,10]. The mean platelet volume (MPV) is a parameter evaluated during the routine blood count and to which clinicians do not usually pay much attention.Recently, MPV has been used as a simpleinflammatory indicator in some disease.[11,12,13]. It has been suggested that the role of this marker is largely influenced by the intensity of inflammation. This study aimed to investigate the MPV in patients with pyelonephritisMaterials and MethodsIn this prospective observational study, 82 patients with pyelonephritis (group A) and 82 patients with viral gastroenteritis (group B) were enrolled randomly from 20 Jun 2013 through 15 Jan 2014. The inclusion criteria for group A were clinical signs and symptoms of pyelonephritis, such as abdominal pain, fever, flank pain, dysuria, etc.; a positive urine culture as > 105 colony forming units per milliliter of a single pathogen in a midstream clean-void urine sample or 104 colony forming units per milliliter of a single pathogen in a urinary catheterization sample. The inclusion criterion for group B was being healthy with uncomplicated viral gastroenteritis with a normal stool exam. Electrolyte, renal function tests, ESR, and CRP were requested. UTI was confirmed using urinalysis and positive urine culture. Renal ultrasound and radioactive nuclide 99mTc-DMSA scanning were performed based on the indications. The patients with any abnormality as scaring on DMSA, renal anomalies, renal enlargement on ultrasonography etc. were excluded from the study. Stool exam and stool culture were requested to rule out a possible bacterial or parasitic infection. In both groups, the patients with any concomitant comorbidity such as renal disease, renal anomaly, confirmed vesicoureteral reflux, history of hematologic disease, diabetes mellitus etc. were excluded from the study. Based on the inclusion and exclusion criteria, 12 patients were excluded from group A and 15 patients were excluded from group B.Complete blood count was performed for all patients using a commercially available analyzer (Sysmex XT 2000i, Roche Diagnostics GmnH, Mannheim, Germany). The hemoglobin level, white blood cell count (WBC), platelet count, and MPV values were recorded for each patient. The reference range for MPV was between 7.0 and 11 FL [7]. Data analysis was performed with SPSS version 20 (IBM Corp., NY, US). The mean, standard deviation, standard error, and frequency were used for descriptive analysis and t-test was used for data analysis. The research followed the tenets of the Declaration of Helsinki. Informed consent was obtained and the Ethics Committee of Arak University of Medical Sciences approved this study. (Grant number# 899)ResultsIn this prospective observational study, 164 patients aged 19.2±12 months were enrolled. In group (A), 51 patients and in group (B), 38 patients were male. All patients were in the normal range for weight, height, and blood pressure. There was no significant difference in demographic characteristics between the two groups (PV>0.05). The patients in both group A had mild to moderate dehydration. The patients in group A were febrile (38-40 ºC) while only 10 cases (12%) in group B had a fever (38-38.5 ºC).The complete blood cell count (CBC) was done for all patients and the mean platelet volume (MPV) was signi icantly lower in group A (PV=0.003). The  mean platelet count (MPC) was also significantly higher in group A (PV=0.006) (Table 1).DiscussionIn this study, MPV was lower in the patients with UTI than patients with gastroenteritis. The mechanism through which MPV decreases during acute pyelonephritis has not been evaluated yet. In a study by Parsa Yousefichaijan et al, MPC was higher in patients with reflux nephropathy than non-reflux nephropathy patients and MPV was lower in patients with reflux nephropathy than patients without re lux nephropathy [1].Mean Platelet Volume in Pyelonephritis - Yousefichaijan P et alJournal of Pediatric Nephrology | Volume 4 | Number 2| 2016 58Table 1. Laboratory tests in group A (pyelonephritis) and group B (viral gastroenteritis)Group A(82 patients) B(82 patients) p-valueAge (year) 18.8±12 19.6± 10 0.12White Blood Cell (number) 13.01 ± 3.43 8.30 ± 1.13 0.001MPV (fl) 6.03 ± 0.26 9.06 ± 0.73 0.003MPC ( number) 219.88 ± 52.31 184.09 ± 52.21 0.006Hemoglobin (gr/dl) 11.5±1.3 12.3±2.4 0.3ESR (mm/hr) 41±2.1 39±3.2 0.6Tekin M evaluated the role of MPV in acute pyelonephritis (APN) and reported that MPV was a fast and reliable measurement with a considerable predictive value for the diagnosis of APN and renal scars whose predictive capacity was better than CRP, ESR, and WBC [11]. F. Catal et al found that the platelet count and MPV were useful markers of the routine measurements in children with upper UTI. The platelet count during upper urinary tract infection was higher in patients with gram-positive infections when compared with gram-negative infections and the patients with upper urinary tract infection had a signi icantly higher MPV [12]. MPV is higher when there is destruction of platelets. This may be seen in inflammatory diseases. Han JS et al showed that 28-day all-cause mortality was significantly higher in patients with MPV≥10.2 fL compared with those with MPV<10.2 fL (P<.001). Therefore, the mean platelet volume at the time of continuous renal replacement therapy initiation may be an inexpensive and useful predictor for 28-day all-cause mortality in patients with AKI requiring continuous renal replacement therapy [13]. MPV levels were significantly lower in children with rotavirus gastroenteritis when compared with controls. There was an inverse relationship between MPV levels and the thrombocyte count, which could be caused by the consumption of large platelets in severe inflammatory conditions, defective thrombopoiesis, or swelling of circulating platelets in an environment rich in activating agents [14,15]. Zareifar S demonstrated a higher platelet counts and lower MPVs in patients with active disease when compared with recovered patients. These parameters were well correlated with the known disease activity markers. They concluded that platelet parameters could be considered reliable markers for the assessment of the disease activity and response to treatment [16]. According to previous studies, MPV decreases in some diseases, such as reflux nephropathy, Crohn’s disease, pulmonary tuberculosis, chronic spontaneous urticaria, etc. [1, 17-20].ConclusionsThis study showed an apparent correlation between MPV and febrile UTI. A multicenter study with a larger sample size is required to investigate the correlation between MPV and pyelonephritis.AcknowledgmentsThis article was extracted from the data of the M.D. thesis of Dr. Elahe Ziaeie and Parisa Kaviani. We appreciate the Research Council and Vice Chancellor for Research of Arak University Medical Sciences that funded the project, and the parents and children who cooperated with us in this project.Conflict of InterestAuthors have no conflict of interest to declare.Financial SupportNone declaredReferences1. Yousefichaijan P, Rafiei M, Eghbali A. et al. Mean Platelet Volume: A useful marker ln reflux nephropathy. J Ped. Nephrology 2014;2(4):137-139.2. Yousefichaijan P, Cyrus A, Dorreh F, et al. Correlation of sacral ratio and reflux – related renal injury in children with and without nephropathy. J Ped. Nephrology 2014;2(3): 116-118.3. Yousefichaijan P, Dorreh F, Rafiei M, et al. Effect of movement and developmental factors in growth and evaluation in children and infants with vesicoureteral reflux. J Renal Inj Prev 2015;4(3):96-100.4. Yousefichaijan P, Cyrus A, Dorreh F, Ahmadi Mohtasham M. Comparing the sacral ratio in children with various degree of Vesicoureteral Mean Platelet Volume in Pyelonephritis - Yousefichaijan P et alJournal of Pediatric Nephrology | Volume 4 | Number 2| 2016 59reflux with children without re lux. AMUJ 2005;10( 3):94-99.5. Yousefi P, Siroos A, Darreh F, Mohtasham MA, Qoran FH, Goldust M.. Sacrum index in children suffering from different grades of VUR. Pak J of biol sci2013;16 (11):545-547.6. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126:1084–91.7. Edefonti A, Tel F, Testa S, De Palma D. Febrile urinary tract infections: clinical and laboratory diagnosis, imaging, and prognosis. SeminNucl Med. 2014;44:123–8.8. Yousefichaijan P, Dorreh Fatemeh. Urinary tract infection due to salmonella in an otherwise healthy child. Iranian journal of kidney diseases 2014;8(2):155-7.9. Elder JS. Urinary tract infection. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia: Saunders; 2011. pp. 1829–38.10. Yousefichaijan P, Sharafkhah M, Cyrus A, Dorreh F, Arjmand A. Is Additional fluid Therapy Effective in the Treatment of Children with Urinary Tract Infections? J Ped Nephrology 2016;4(1):25-29.11. Tekin M, Konca C, Gulyuz A, Uckardes F, Turgut M. Is the mean platelet volume a predictive marker for the diagnosis of acute pyelonephritis in children? ClinExpNephrol. 2014 ;4.12. Catal F, Bavbek N, Bayrak O, et al. Platelet parameters in children with upper urinary tract infection: is there a specific response? Ren Fail. 2008;30(4):377-81.13. Han JS, Park KS, Lee MJ, et al., Mean platelet volume is a prognostic factor in patients with acute kidney injury requiring continuous renal replacement therapy, J Crit Care 2014;29(6):1016-21. 14. Mete E, Akelma AZ, Cizmeci MN, Bozkaya D, Kanburoglu MK. Decreased mean platelet volume in children with acute rotavirus gastroenteritis. Platelets 2014;25(1):51-4.15. Tanju C, Ekrem G, BerksoyEmel A, Nur A. Mean platelet volume as a negative marker of inflammation in children with rotavirus gastroenteritis. Iran J Pediatric. 2014 Oct; 24(5):617-22.16. Zareifar S, Farahmand Far MR, Golfeshan F, Cohan N. Changes in platelet count and mean platelet volume during infectious and inflammatory disease and their correlation with ESR and CRP. J Clin Lab Anal2014 May; ]28(3):245-8.17. Kapsoritakis AN, Koukourakis MI, Sfiridaki A, et al. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterology 2001;96:776–781.18. Song Liu, Jiana Ren, Gang Han, Gefei Wang. MPV: controversial marker of disease activity in Crohn’sdisease. Euro J Med Res 2012;17(1):27.19. GulsahGunluoglu,EsraErtanYazar,NurdanSimsekVeske, EkremCengizSeyhan, SedatAltin. MPV as an inflammation marker in active pulmonary tuberculosis. Multidiscipline Respir Med 2014; 9(1):11.20. Akelma AZ, Mete E, Cizmeci MN, Kanburoglu MK, Malli DD, Bozkaya D. The role of MPV as an inflammatory marker in children. Allergol Immunopathology (Madr) 2013 Aug 19.

The Mean Platelet Volume in children with Pyelonephritis

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The Mean Platelet Volume in children with Pyelonephritis

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