***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis . The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a(1)-antitrypsin complex ( E-a(1)-Pi ) for the detection of  acute pyelonephritis in children . METHODS Eighty-three patients , 29 boys and 54 girls , 25 days to 14 years of age , with first-time symptomatic urinary tract infection were prospect ively studied . Fifty-seven healthy children served as controls .  Dimercaptosuccinic acid ( DMSA ) scan and voiding cystourethrography were performed in all patients . Plasma and urinary E-a(1)-Pi , C-reactive protein ( CRP ) , erythrocyte sedimentation rate ( ESR ) , neutrophil count , urinary N-acetyl-beta-glucosaminidase ( NAG ) , N-acetyl-beta-glucosaminidase b ( NAG b ) , and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics . The same markers were also measured in the control subjects . RESULTS Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children ( group A ) . It was normal in the remaining 53 children ( group B ) . The sex and age distributions were not significantly different between the 2 groups , as well as between the patients and the control subjects ( group C ) . Nineteen of the 53 children with a normal DMSA had body temperature > /=38 degrees C , whereas all but 4 children with abnormal DMSA had temperature > /=38 degrees C. Therefore , the temperature was significantly different between these 2 groups . The sensitivity and specificity of fever ( > /=38 degrees C ) as an indicator of renal involvement based on isotopic findings were 86 % and 64 % , respectively . Given the significant number of the febrile children with normal DMSA scintiscans , group B was subdivided into B(1 ) with 19 febrile children ( 14 boys and 5 girls ) and B(2 ) with 34 children whose body temperature was below 38 degrees C ( 8 boys and 26 girls ) . The sex and age distribution was significantly different between groups B(1 ) and B(2 ) . The mean age of group B(1 ) was.78 years ( range : 28 days to 9 years ; median:.25 years ; st and ard deviation : 2.1 ) . All but 1 child in this group were younger than 1 year of age . In contrast , in group B(2 ) , there were only 4 infants , the remaining 30 children were older than 2.5 years ( mean age : 6 years ; median : 7 years ; st and ard deviation : 3.5 ; range : 34 days to 12 years ) . The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B(1 ) . This difference was not statistically significant . Similarly , body temperature was not significantly different between these 2 groups . The distribution of plasma E-a(1)-Pi values was normal in the control subjects . The sensitivity and specificity of plasma E-a(1)-Pi , as an indicator of renal involvement , were 96 % and 50 % , respectively , taking the 95th percentile of the reference range as a cutoff value . However , considering as a cutoff value the level of 72 microg/dL ( 95th percentile of group B(2 ) ) , its sensitivity and specificity were 74 % and 86 % , respectively . Plasma E-a(1)-Pi levels were significantly elevated in group A compared with group B and in both groups , the plasma E-a(1)-Pi values were significantly higher than in the control subjects . A significant difference also was noticed between group A and each of the subgroups B(1 ) and B(2 ) and also between the subgroups themselves . Plasma E-a(1)-Pi concentrations correlated significantly with neutrophil count in groups A ( r = .3 ) , B ( r = .4 ) , and B(2 ) ( r = .46 ) , but the correlation was not significant in group B(1 . ) ESR levels showed , among the different groups , similar differences with those of E-a(1)-Pi values . Unlike E-a(1)-Pi , CRP levels were comparable between groups A and B(1 ) , which both consisted of febrile children . Neutrophil count was not significantly different between subgroups B(1 ) and B(2 ) . ( ABSTRACT TRUNCATED Background . The st and ard recommendation for treatment of young , febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials . The availability of potent , oral , third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy . Methods . In a multicenter , r and omized clinical trial , we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection , in terms of short-term clinical outcomes ( sterilization of the urine and defervescence ) and long-term morbidity ( incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans ) . Children received either oral cefixime for 14 days ( double dose on day 1 ) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days . Results . Treatment groups were comparable regarding demographic , clinical , and laboratory characteristics . Bacteremia was present in 3.4 % of children treated orally and 5.3 % of children treated intravenously . Of the short-term outcomes , 1 ) repeat urine cultures were sterile within 24 hours in all children , and 2 ) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously , respectively . Of the long-term outcomes , 1 ) symptomatic reinfections occurred in 4.6 % of children treated orally and 7.2 % of children treated intravenously , 2 ) renal scarring at 6 months was noted in 9.8 % children treated orally versus 7.2 % of children treated intravenously , and 3 ) mean extent of scarring was ∼8 % in both treatment groups . Mean costs were at least twofold higher for children treated intravenously ( $ 3577 vs $ 1473 ) compared with those treated orally . Conclusions . Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection . Use of cefixime will result in substantial reductions of health care expenditures This prospect i ve study , performed in 76 children with a urinary tract infection ( UTI ) , evaluates the diagnostic value of procalcitonin ( PCT ) and proinflammatory cytokines ( IL-1β , IL-6 and TNF-α ) in children with acute pyelonephritis documented by dimercaptosuccinic acid scintigraphy ( DMSA ) .  Renal parenchymal involvement was assessed by 99 m Tc-DMSA scintigraphy within 7 days of admission . The diagnosis of acute pyelonephritis was confirmed only in patients with reversible lesions on scintigraphy . According to DMSA scan results , patients were divided into two groups , lower UTI or acute pyelonephritis . In acute pyelonephritis , serum PCT level was found to be significantly higher than it is in the lower UTI ( p < 0.001 ) . Also , significantly higher serum proinflammatory cytokines ( IL-1β , IL-6 and TNF-α ) levels were detected in those with acute pyelonephritis than those with lower UTI ( p < 0.001 ) . We conclude that both serum PCT and proinflammatory cytokine levels may be used as accurate markers for diagnosis of acute pyelonephritis Four recent prospect i ve studies have suggested that procalcitonin ( PCT ) , a polypeptide produced by the macrophage-monocyte system during severe bacterial infection , might be more specific than leukocyte count or  C-reactive protein ( CRP ) in predicting acute renal involvement during an episode of febrile urinary tract infection ( UTI ) [ 1 , 2 , 3 , 5 ] . The aim of our prospect i ve study was to confirm such findings OBJECTIVE Febrile urinary tract infection ( UTI ) is a common problem among children . The diagnosis and management of acute pyelonephritis is a challenge , particularly during infancy . The distinction between acute pyelonephritis and UTI without renal involvement is very important , because renal infection may cause parenchymal scarring and thus requires more aggressive investigation and follow-up monitoring . However , this distinction is not easy among children , because common clinical findings and laboratory parameters are nonspecific , especially among young children . In an attempt to differentiate acute pyelonephritis from febrile UTI without renal lesions in a group of 100 children , we measured serum levels of procalcitonin ( PCT ) , a new marker of infection . The objective of the study was to determine the accuracy of  PCT measurements , compared with C-reactive protein ( CRP ) measurements , in diagnosing acute renal involvement during febrile UTI and in predicting subsequent scars , as assessed with 99mTc-dimercaptosuccinic acid ( DMSA ) scintigraphy . DESIGN  Serum CRP levels , erythrocyte sedimentation rates , leukocyte counts , and PCT levels  were measured for 100 children , 1 month to 13 years of age , admitted for suspected febrile UTI ( first episode ) . Renal parenchymal involvement was evaluated with DMSA scintigraphy within 5 days after admission . The DMSA study was repeated 6 months later if the initial results were abnormal . RESULTS The mean PCT level was significantly higher in acute pyelonephritis than in UTI without renal lesions ( 4.48 + /- 5.84 ng/mL vs 0.44 + /- 0.30 ng/mL ) . In these 2 groups , the mean CRP levels were 106 + /- 68.8 mg/L and 36.4 + /- 26 mg/L , mean erythrocyte sedimentation rates were 79.1 + /- 33 mm/hour and 58.5 + /- 33 mm/hour , and leukocyte counts were 18 492 + /- 6839 cells/mm3 and 16 741 + /- 5302 cells/mm3 , respectively . For the prediction of acute pyelonephritis , the sensitivity and specificity of PCT measurements were 83.3 % and 93.6 % , respectively ; CRP measurements had a sensitivity of 94.4 % but a specificity of only 31.9 % . Positive and negative predictive values for prediction of renal involvement with PCT measurements were 93.7 % and 83 % and those with CRP measurements were 61.4 % and 83.3 % , respectively . When inflammatory markers were correlated with the severity of the renal lesions , as assessed with DMSA scintigraphy , a highly significant correlation with both PCT and CRP levels was found . However , when the 2 parameters were correlated with renal scarring in follow-up scans , a significant positive association was found only for PCT levels . CONCLUSIONS  Serum PCT levels may be a sensitive and specific measure for early diagnosis of acute pyelonephritis and determination of the severity of renal parenchymal involvement . Therefore , this measurement could be useful for the treatment of children with febrile UTIs , allowing prediction of patients at risk of permanent parenchymal renal lesions OBJECTIVES . The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment , given parenterally if necessary . In support of this recommendation , data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited . Because the risk was not well defined , we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children . METHODS . The research findings are derived from 2 multicenter , prospect i ve , r and omized , controlled studies , Italian Renal Infection Study 1 and 2 , whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis , respectively . From the 2 studies , we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later . The children were 1 month to < 7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy . RESULTS . Progressive delay in antibiotic  treatment of acute pyelonephritis from < 1 to ≥5 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later . The risk of scarring remained relatively constant at 30.7 ± 7 % . Clinical and laboratory indices of inflammation were comparable in all groups , as was the incidence of vesicoureteric reflux . CONCLUSIONS . Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring . Furthermore , there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with 
    Output:
    
The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis .
A low CRP value ( < 20 mg/L ) appears to be somewhat useful in ruling out pyelonephritis ( decreasing the probability of pyelonephritis to < 20 % ) , but unexplained heterogeneity in the data prevents us from making recommendations at this time .
Thus , at present , we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice