Serum procalcitonin for prediction of renal parenchymal involvement in children with urinary tract infections: a meta-analysis of prospective clinical studies

J Pediatr. 2009 Dec;155(6):875-881.e1. doi: 10.1016/j.jpeds.2009.06.037. Epub 2009 Oct 21.


Objective: To determine by meta-analysis whether serum procalcitonin (PCT) is a useful marker of acute renal parenchymal involvement (RPI) in children with culture-proven urinary tract infection (UTI), as diagnosed by acute-phase DMSA (Tc-99m dimercaptosuccinic acid) renal scintigraphy.

Study design: We searched PubMed and the Cochrane Central Register of Controlled Trials for prospective studies involving children with culture-proven UTIs. Additional eligibility criteria were measurement of serum PCT at presentation and performance of DMSA scintigraphy within 14 days.

Results: Overall, 10 studies eligible for inclusion, involving a total of 627 children, were identified. Half of these studies evaluated children with a first episode of UTI; 8 involved children with febrile UTIs. Using a cutoff value of 0.5 to 0.6 ng/mL, the pooled diagnostic odds ratio of serum PCT for UTI with RPI was 14.25 (95% confidence interval, 4.70 to 43.23). High statistical between-study heterogeneity that could mainly be attributed to 2 studies was observed. The remaining 8 studies uniformly favored PCT use.

Conclusions: In children with culture-proven UTI, a serum PCT value >0.5 ng/mL predicts reasonably well the presence of RPI, as evidenced by DMSA scintigraphy. PCT may aid in the identification of children with UTI, necessitating more intense evaluation and management.

Publication types

  • Meta-Analysis

MeSH terms

  • Calcitonin / blood*
  • Calcitonin Gene-Related Peptide
  • Child
  • Child, Preschool
  • Clinical Trials as Topic
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Nephrons / diagnostic imaging*
  • Nephrons / microbiology
  • Nephrons / pathology*
  • Predictive Value of Tests
  • Protein Precursors / blood*
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Technetium Tc 99m Dimercaptosuccinic Acid
  • Urinary Tract Infections / blood*
  • Urinary Tract Infections / diagnostic imaging
  • Urinary Tract Infections / pathology


  • CALCA protein, human
  • Protein Precursors
  • Radiopharmaceuticals
  • Technetium Tc 99m Dimercaptosuccinic Acid
  • Calcitonin
  • Calcitonin Gene-Related Peptide