Urinary biomarkers in children with urinary tract infections with and without reflux on antibacterial prophylaxis with cefaclor

Objective: To determine the effects of cefaclor prophylaxis on sensitive urinary biomarkers of renal tubular damage in children with recurrent urinary tract infections. Design: Urinary levels of alpha(1)-microglobulin (alpha(1)-m) and N-acetyl-beta-D-glucosaminidase (NAG) were compared in children with recurrent urinary tract infections on antibacterial prophylaxis with cefaclor and in an untreated control group. Setting: A university paediatric department; patients were followed in a day hospital. Participants and Interventions: Thirty-eight patients (20 males and 18 females aged from 1 to 12 years) with at least two episodes of urinary tract infections in the previous 2 months received cefaclor (20 mg/kg/day in a single bedtime dose) for a minimum of 2 months. After 1 month of treatment all patients underwent BUN and serum creatinine, urine analysis and urine cultures, renal ultrasonography (found to be normal in all cases) and voiding urethrocystography (six cases of vesicoureteric reflux were observed). Results were compared with those from a healthy age-matched untreated control group of 36 children. Main Outcome Measures and Results: In the 32 patients without vesicoureteric reflux, the NAG value was 1.44 +/- 1.77 U/mmol creatinine, while the alpha(1)-m value was 2.10 +/- 1.67 U/mmol creatinine. No significant difference in these parameters was found versus the upper limit of control values (mean values + 2 SD: 1 and 1.6 U/mmol creatinine, respectively). In the six patients who had vesicoureteric reflux, NAG and alpha(1)-m values were significantly higher than in controls (p < 0.05); 3.08 +/- 4.09 and 2.85 +/- 3.71 U/mmol creatinine, respectively. Conclusions: Cefaclor prophylaxis was well tolerated at the renal level in children with recurrent urinary tract infections. However, urinary biomarker excretion is increased in the presence of vesicoureteric reflux.