ESPN 54th Annual Meeting

ESPN 2022


 
Urinary HSP70 improves diagnostic accuracy for urinary tract infection in children: UTILISE Study
ALEV YILMAZ 1 ALBERTO CALDAS AFONSO 3 IPEK AKIL 4 BAGDAGUL AKSU 2 HARIKA ALPAY 5 BAHRIYE ATMIS 6 OZLEM AYDOG 8 AYSUN KARABAY BAYAZIT 7 MERAL TORUN BAYRAM 9 ILMAY BILGE 10 IPEK KAPLAN BULUT 11 BAHAR BUYUKKARAGOZ 12 ELIF COMAK 13 BELDE KASAP DEMIR 14 NIDA DINCEL 15 OSMAN DONMEZ 16 MEHMET AKIF DURMUS 17 HASAN DURSUN 18 RUHAN DUSUNSEL 19 ALI DUZOVA 20 PELIN ERTAN 4 ASUMAN GEDIKBASI 21 NILUFER GOKNAR 22 SERCIN GUVEN 5 DUYGU HACIHAMDIOGLU 23 AUGUSTINA JANKAUSKIENE 24 MUKADDES KALYONCU 45 SALIH KAVUKCU 9 BAHRIYE UZUN KENAN 12 NURAN KUCUK 25 BAHAR KURAL 26 MIECZYSłAW LITWIN 27 GIOVANNI MONTINI 28 WILLIAM MORELLO 28 AHMET NAYIR 1 LUKASZ OBRYCKI 27 BEYHAN OMER 29 EBRU MISIRLI OZDEMIR 30 NESE OZKAYIN 31 DUSAN PARIPOVIC 32 CEMILE PEHLIVANOGLU 33 SEHA SAYGILI 34 SUSANNE SCHAEFER 35 FERAH SONMEZ 36 YILMAZ TABEL 37 NESRIN TAS 20 MEHMET TASDEMIR 10 ANA TEIXEIRA 3 DEMET TEKCAN 8 SEBAHAT TULPAR 38 OZDE NISA TURKKAN 5 BERFIN UYSAL 39 METIN UYSALOL 40 DAIVA VAICIUNIENE 24 SEVGI YAVUZ 41 SIBEL YEL 19 TARIK YILDIRIM 42 ZEYNEP YURUK YILDIRIM 1 NURDAN YILDIZ 5 SELCUK YUKSEL 43 ERAY YURTSEVEN 44 FRANZ SCHAEFER 35 REZAN TOPALOGLU 20

1- DIVISION OF PEDIATRIC NEPHROLOGY, ISTANBUL FACULTY OF MEDICINE, ISTANBUL UNIVERSITY
2- DEPARTMENT OF PEDIATRICS BASIC SCIENCES, INSTITUTE OF CHILD HEALTH, ISTANBUL UNIVERSITY
3- DIVISION OF PEDIATRIC NEPHROLOGY, CENTRO MATERNO INFANTIL DO NORTE, CENTRO HOSPITALAR UNIVERSITáRIO DO PORTO
4- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, CELAL BAYAR UNIVERSITY
5- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, MARMARA UNIVERSITY
6- DIVISION OF PEDIATRIC NEPHROLOGY, ERZURUM TRAINING AND RESEARCH HOSPITAL
7- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, CUKUROVA UNIVERSITY
8- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, ONDOKUZ MAYIS UNIVERSITY
9- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, DOKUZ EYLUL UNIVERSITY
10- DIVISION OF PEDIATRIC NEPHROLOGY, DEPARTMENT OF PEDIATRICS, SCHOOL OF MEDICINE, KOC UNIVERSITY
11- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, EGE UNIVERSITY
12- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, GAZI UNIVERSITY
13- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, AKDENIZ UNIVERSITY
14- DIVISION OF PEDIATRIC NEPHROLOGY, TEPECIK TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
15- DIVISION OF PEDIATRIC NEPHROLOGY, DR. BEHCET UZ CHILDREN DISEASES TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
16- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, ULUDAG UNIVERSITY
17- DEPARTMENT OF MEDICAL MICROBIOLOGY, ISTANBUL FACULTY OF MEDICINE, ISTANBUL UNIVERSITY
18- DIVISION OF PEDIATRIC NEPHROLOGY, OKMEYDANI TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
19- DIVISION OF PEDIATRIC NEPHROLOGY, ERCIYES UNIVERSITY, FACULTY OF MEDICINE
20- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, HACETTEPE UNIVERSITY
21- DEPARTMENT OF RARE DISEASES, INSTITUTE OF CHILD HEALTH, ISTANBUL UNIVERSITY
22- DIVISION OF PEDIATRIC NEPHROLOGY, BAGCILAR TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
23- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, BAHCESEHIR UNIVERSITY
24- CLINIC OF PEDIATRICS, INSTITUTE OF EXPERIMENTAL AND CLINICAL MEDICINE, VILNIUS UNIVERSITY, VILNIUS
25- DIVISION OF PEDIATRIC NEPHROLOGY, KARTAL TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
26- DEPARTMENT OF PEDIATRICS, BAKIRKÖY SADI KONUK TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
27- DIVISION OF NEPHROLOGY, KIDNEY TRANSPLANTATION AND HYPERTENSION, THE CHILDRENS MEMORIAL HEALTH INSTITUTE
28- PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, FONDAZIONE IRCCS CA’ GRANDA - OSPEDALE MAGGIORE POLICLINICO
29- DEPARTMENT OF BIOCHEMISTRY, ISTANBUL FACULTY OF MEDICINE, ISTANBUL UNIVERSITY
30- DEPARTMENT OF PEDIATRICS, OKMEYDANI TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
31- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, TRAKYA UNIVERSITY
32- DIVISION OF PEDIATRIC NEPHROLOGY, UNIVERSITY CHILDRENS HOSPITAL
33- DIVISION OF PEDIATRIC NEPHROLOGY, UMRANIYE TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
34- DIVISION OF PEDIATRIC NEPHROLOGY, CERRAHPASA FACULTY OF MEDICINE, ISTANBUL UNIVERSITY-CERRAHPASA
35- DIVISION OF PEDIATRIC NEPHROLOGY, CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG UNIVERSITY
36- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, ADNAN MENDERES UNIVERSITY
37- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, INONU UNIVERSITY
38- DIVISION OF PEDIATRIC NEPHROLOGY, BAKIRKOY DR. SADI KONUK TRAINING AND RESEARCH HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
39- DIVISION OF PEDIATRIC NEPHROLOGY, DORTCELIK CHILDRENS HOSPITAL
40- DIVISION OF PEDIATRIC EMERGENCY, ISTANBUL FACULTY OF MEDICINE, ISTANBUL UNIVERSITY
41- DIVISION OF PEDIATRIC NEPHROLOGY, KANUNI SULTAN SULEYMAN RESEARCH AND TRAINING HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
42- DEPARTMENT OF PEDIATRICS, KANUNI SULTAN SULEYMAN RESEARCH AND TRAINING HOSPITAL, UNIVERSITY OF HEALTH SCIENCES
43- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, PAMUKKALE UNIVERSITY
44- DEPARTMENT OF BIOSTATISTICS, ISTANBUL FACULTY OF MEDICINE, ISTANBUL UNIVERSITY
45- DIVISION OF PEDIATRIC NEPHROLOGY, FACULTY OF MEDICINE, KARADENIZ TECHNIC UNIVERSITY
 
Introduction:

 The accuracy of conventional urinalysis in diagnosing urinary tract infection (UTI) in children is limited, leading to unnecessary antibiotic exposure in a large fraction of patients. Urinary Heat Shock Protein 70 (uHSP70) is a novel marker of acute urinary tract inflammation. We explored the added value of uHSP70 in discriminating UTI from other infections and conditions confused with UTI.

Material and methods:

 802 children from 37 pediatric centers in seven countries participated in the study. Patients diagnosed with UTI (n=191), non-UTI infections (n=178), contaminated urine samples (n=50), asymptomatic bacteriuria (n=26), and healthy controls (n=75) were enrolled. Urine and serum levels of HSP70 were measured at presentation in all patients and after resolution of the infection in patients with confirmed UTI. 

Results:

 Urinary (u)HSP70 was selectively elevated in children with UTI as compared to all other conditions (p<0.0001). uHSP70 predicted UTI with 88.5% sensitivity and 82.2% specificity (AUC=0.934). Among the 265 patients with suspected UTI, the uHSP70 >48 ng/mL criterion identified the 172 children with subsequently confirmed UTI with 90.1% sensitivity and 82.4% specificity (AUC=0.862), exceeding the individual diagnostic accuracy of leukocyturia, nitrite and leukocyte esterase positivity. uHSP70 had completely normalized by the end of antibiotic therapy in the UTI patients. Serum HSP70 was not predictive.

Conclusions:

 Urine HSP70 is a novel non-invasive marker of UTI that improves the diagnostic accuracy of conventional urinalysis. We estimate that rapid urine HSP70 screening could spare empiric antibiotic administration in up to 80% of children with suspected UTI.