A STUDY OF RELATIONSHIP BETWEEN URINARY INTERLEUKINS 1 AND 6 AND ACUTE PHASE REACTANTS IN ACUTE PYELONEPHRITIS IN CHILDREN.

Pyelonephritis is one of the most serious and common infectious diseases in children. Renal infection and scarring is the leading cause of the end stage renal disease (ESRD) in some parts of the world (i.e. Iran). Urinary Interleukins 1 and 6 have been reported to be high in acute pyelonephritis in some of the previous studies. The study was conducted to examine whether urinary interleukins 1 and 6 is high and can be used as a screening test for acute pyelonephritis and relation between amount of these cytokines, and acute phase reactants, and severity of pyelonephritis as is determined by Dimercaptosuccinic acid (DMSA) scan during infection.

Materials & Methods:�Children, 1 month to 12 years old, admitted at the nephrology ward of Mofid Children's hospital for pyelonephritis from January to July 2004 were enrolled in the study.

Interleukin 1 and 6 and creatinine were measured in 80 random urine samples obtained at the time of admission from 37 patients (81% female) with acute pyelonephritis and in 43 non-febrile normal children (35 female). Urinary interleukins were measured by Enzyme Linked Immunosorbent Assay (ELISA) and the creatinine by spectrophotometry and recorded as microgram per mg creatinine. The C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) was measured by standard methods. Pyelonephritis was confirmed by positive urine culture and/or DMSA scan in all patients using SPECT apparatus. The data were analyzed by paired two tail student T test and correlation curves using Excel software and the differences were considered significant if p< 0.05.

Results: Mean interleukin 1/creatinine (Int1/Cr) in patients with pyelonephritis was 0.70± 0.96 (range 0.02-5.08) and 0.04± 0.12 (range 0-0.51) in normal children (p=0.0002). Mean interleukin 6/creatinine (Int6/Cr) in patients with pyelonephritis was 4.80±10.06 (range 0.01-44.73) and 0.15±2.32 (range 0-0.51) in normal children (p=0.008). There was no significant correlation between interleukin 1 and 6 and CRP, ESR, leukocytosis, leukocyturia and severity of pyelonephritis.

Conclusion: There were significantly higher levels of urinary IL-1 and IL-6 in children with pyelonephritis than normal children. But there was no significant correlation between interleukin 1 and 6 and CRP, ESR, leukocyturia and severity of pyelonephritis