Clinical Significance of Pyuria in Pediatric Patients with Febrile Urinary Tract Infection

Choi, Lim; Cho, Sea Eun; Yim, Hyung Eun; Yoo, Kee Hwan; Hong, Young Sook; Lee, Joo Won

Abstract

PURPOSE
Early diagnosis and treatment of febrile urinary tract infection (UTI) in children is important to prevent kidney damage. This study aims to evaluate the relationship between the presence of pyuria, the severity, and underlying genitourinary anomalies in patients with UTI. METHODS: We retrospectively reviewed 293 patients with febrile UTI who were admitted to Korea University Guro Hospital during the period from June, 2007 until January, 2010. We divided the patients into two groups, one with the finding of pyuria at admission, and the other without, and compared the fever duration, white blood cell counts (WBC) and C-reactive protein (CRP) in peripheral bloods, hydronephrosis, cortical defects, vesicoureteral reflux and admission period.
RESULTS
Among the 293 patients with febrile UTI, 189 patients showed findings of pyuria whereas 104 patients did not. Patients with pyuria showed an increment of WBC (14,694+/-485.2 vs. 11,374+/-451.2/uL, P<0.05) and CRP (46.9+/-3.9 vs 17.1+/-3.6 mg/L, P<0.05) in peripheral blood sample. The presence of cortical defects (21.7 Vs 5.8%, P<0.05) and vesicoureteral reflux (15.9 Vs 6.7%, P<0.05) was also increased in patients with pyuria compared to patients without pyuria. There were no specific differences in fever duration, admission period, and hydronephrosis. Within the group with pyuria, CRP in peripheral blood sample increased proportionally with the increment of pyuria (P<0.05).
CONCLUSION
In patients with febrile UTI, the increment of WBC in the urine sample can be a helpful predictor for increased CRP in peripheral blood and acute pyelonephritis.