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New marker for pyelonephritis?

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In a study of children with acute pyelonephritis plasma and urine concentrations of soluble adhesins E-selectin (sE-selectin) and soluble intercellular adhesion molecule 1 (sICAM-1) do not predict renal scarring, despite a previous report of raised plasma concentrations in children with kidney damage associated with vesicoureteric reflux. An unexpected finding, though, is that because of the consistent presence of sE-selectin in urine early in infection, it might be a useful marker for acute pyelonephritis.

sE-selectin concentration in plasma and urine was higher in samples taken up to a week after onset of pyelonephritis (acute samples) than in later samples or healthy controls or controls with fever unrelated to urinary infection. sICAM-1 concentration in plasma was higher in the acute and later samples than in both controls whereas in urine it was significantly higher only in acute samples compared with controls with unrelated febrile illness. Although abnormalities of renal parenchyma were evident on DMSA imaging in three quarters of children within one week after presentation, persisting in a few up to six weeks, they did not correlate with the plasma and urinary sE-selectin and sICAM-1 profiles.

The study compared 40 children with a first episode of acute pyelonephritis, who had plasma and urine samples taken one week and six weeks after presentation, with 21 healthy controls and—to check for specificity—a further 18 controls with a fever but no urinary infection, all matched for age and sex

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