| Abstract | Cilj: Izmjeriti visinu nalaza uNGAL-a i ispitati njegovu dijagnostičku vrijednost u dijagnozi AP-a. Ispitanici: Prospektivno presječno ispitivanje 127-ero djece s povišenom tjelesnom temperaturom podijeljenih u ispitivanu skupinu s 83-oje djece i kontrolnu skupinu s 44-ero djece s respiratornim i gastrointestinalnim upalnim bolestima. Materijal i metode: Svoj djeci učinjeni su CRP, PCT, L, uNGAL, sediment mokraće i kultura mokraće. Djeci s AP-om učinjeni su UZ mokraćnog sustava i statička scintigrafija bubrega Tc-99m DMSA. Rezultati: U ispitivanoj skupini djece s AP-om značajno je više ženske djece. Djeca s AP-om imaju statistički značajno više vrijednosti svih ispitivanih upalnih čimbenika: CRP-a, PCT-a i L. Također, djeca s AP-om imaju značajno više vrijednosti uNGAL-a od djece kontrolne skupine. Za dijagnozu AP-a izmjerene su granične vrijednosti upalnih čimbenika: uNGAL-a >29,4 ng/ml, CRP-a >45 mg/l, PCT-a >0,9 ng/ml. Najznačajniji u dijagnozi AP-a pokazao se uNGAL. Djeca dojenačke dobi i muška djeca s AP-om imala su značajno više vrijednosti uNGAL-a. Najčešće izolirana bakterija bila je E. coli (83,3 %). Leukociturija u mokraći bila je značajno više izražena kod djece ispitivane skupine. Zaključak: U ovom istraživanju utvrđeno je da su svi korišteni čimbenici upale značajno viših vrijednosti kod djece s AP-om. To su CRP, PCT, L te ispitivani novi biomarker upale, uNGAL. NGAL iz mokraće statistički je značajno viši kod djece koja su liječena zbog AP-a. U usporedbi s ostalim upalnim parametrima, uNGAL kod granične vrijednosti >29,4 ng/ml pokazao se najznačajnijim dijagnostičkim pokazateljem AP-a s osjetljivošću od 92,4 % i sa specifičnošću od 95,8 %. Mogao bi se koristiti kao rani i pouzdani biomarker u predviđanju dijagnoze AP-a. Tim više jer je analiza navedenog biomarkera jednostavna, neinvazivna i dovoljna je vrlo mala količina mokraće (150µl), a rezultat nalaza gotov je za 35 minuta. Analizom dobivenih rezultata zaključeno je da su, osim nalaza uNGAL-a u dijagnozi AP-a, isto tako važni i ostali upalni parametri kao što su CRP, PCT, leukociti u serumu, broj leukocita u sedimentu mokraće i mikrobiološki nalaz mokraće. |
| Abstract (english) | Objective: The aim of this thesis is to measure the level of findings of the NGAL in urine and determine its diagnostic value in the diagnosis of AP in children. Participants: In the prospective cross-sectional study, 127 children with fever were divided into two groups. The first group of children consisted of 83 children with AP, while the second, the control group, consisted of 44 children with inflammatory diseases of the respiratory and gastrointestinal tracts. Material and methods: The following laboratory tests were done in all children: CRP, PCT, serum leukocytes, uNGAL, analysis of urine sediment, and urine culture. In children diagnosed with AP, an ultrasound of the urinary tract and static scintigraphy of the kidneys Tc-99m DMSA were performed. Results: In the treated group of children with AP, there are significantly more female children. There was a statistically significant difference in CRP, PCT, and serum leukocyte levels between the treatment and control groups of children. Cut-off values of inflammatory parameters were measured to predict the diagnosis of AP. At the cut-off value of uNGAL > 29.4 ng/ml, at the cut-off value of CRP > 45 mg/l, at the cut-off value of PCT > 0.9 ng/ml. The uNGAL value was most significant in children with AP. Infants with AP and male children had significantly higher uNGAL values. The most common isolated cause of urinary tract infection was E. coli, in 83.3% of cases. Urinary leukocyturia was significantly more prevalent in the treatment group than in the control group. Conclusion: In this study, it was found that all observed inflammatory parameters were significantly increased in children with acute pyelonephritis. These were CRP, PCT, serum leukocytes, and a new inflammatory biomarker uNGAL. Urinary NGAL was statistically significantly increased in children treated for AP. Compared to other inflammatory parameters, uNGAL proved to be the most important diagnostic indicator for AP at the cut-off value > 29.4 ng/ml, with a sensitivity of 92.4 % and a specificity of 95.8 %. The conclusion is that it could be used as an early and reliable biomarker for predicting the diagnosis of AP, especially because the analysis of this biomarker is simple and non-invasive, and a very small amount of urine, i.e., 150µl, is sufficient. The results are available within 35 minutes. The analysis of the obtained results showed that besides uNGAL, other inflammatory parameters such as CRP, PCT, serum leukocytes, number of leukocytes in urine sediment, and microbiological urine findings are also important in the diagnosis of AP. |
