High sensitive C-reactive protein: a new marker for urinary tract infection, VUR and renal scar.

BACKGROUND Accurate diagnosis and early treatment of urinary tract infections (UTI) are important because of its association with renal scarring (RS). AIMS To investigate the serum levels of fibronectin, high sensitive CRP (Hs-CRP), urinary fibronectin, and beta-2 microglobulin (beta2MG) levels in patients with UTI and relationship of these parameters with VUR (vesicoureteral reflex) and RS. PATIENTS AND METHODS 72 patients were included in study and divided into three groups: Group I (20 patients with first UTI); Group II (16 patients with recurrent UTI with VUR); Group III (16 patients without UTI with VUR). RESULTS Serum and urine fibronectin levels were similar in all study groups and controls. Urinary beta2MG levels were higher in Group II (302±179 ng/ml) than in the Group I (134±90 ng/ml) (p < 0.001). Moreover, beta2MG levels were similar in Group II (302±179 ng/ml) and group III (218±147 ng/ml). By contrast, beta2MG levels were higher in Group III (218±147 ng/ml) than in the controls (64±32 ng/ml) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L), Group II (23.1±32 mg/L), and III (0.4±0.1 mg/L) than the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP levels were higher in Group II (23.1±31.9 mg/L) than in the Group I (1.8±2.7 mg/L) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L) and Group II (23.1±31.9 mg/L) than in the Group III (0.4±0.1 mg/L) (p < 0.001). Hs-CRP levels were higher in group III (0.37±0.17 mg/L) than in the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP (18.8±25 mg/L) and beta2MG levels (349.4±128.5 ng/ml) were different in UTI with RS from the controls (0.2±0.08 mg/L and 64±32 ng/ml respectively, p < 0.001). Fibronectin levels were similar in patients with and without RS. CONCLUSIONS Increased urinary beta2MG and Hs-CRP were observed in initial UTI and recurrent UTI with VUR. Fibronectin levels were not useful for detection of first and recurrent UTI with VUR and RS. Elevated Hs-CRP levels can help us predetermine the patients with VUR prone to proceed to clinical chronic renal failure.