Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial

Background To evaluate the efficacy of adjuvant systemic corticosteroids in reducing kidney scarring. A previous study suggested that use of adjuvant systemic corticosteroids reduces kidney scarring in children radiologically confirmed to have extensive pyelonephritis. Efficacy of corticosteroids fo...

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Published in:Pediatric nephrology (Berlin, West) West), 2020-11, Vol.35 (11), p.2113-2120
Main Authors: Shaikh, Nader, Shope, Timothy R., Hoberman, Alejandro, Muniz, Gysella B., Bhatnagar, Sonika, Nowalk, Andrew, Hickey, Robert W., Michaels, Marian G., Kearney, Diana, Rockette, Howard E., Charron, Martin, Lim, Ruth, Majd, Massoud, Shalaby-Rana, Eglal, Kurs-Lasky, Marcia, Cohen, Daniel M., Wald, Ellen R., Lockhart, Greg, Pohl, Hans G., Martin, Judith M.
Format: Article
Language:English
Subjects:
Children
Cicatrices
Complications and side effects
Corticosteroids
Diseases
Drug therapy
Kidney diseases
Medicine
Medicine & Public Health
Nephrology
Original Article
Patient outcomes
Pediatrics
Prevention
Urinary tract infections
Urology
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Summary:Background To evaluate the efficacy of adjuvant systemic corticosteroids in reducing kidney scarring. A previous study suggested that use of adjuvant systemic corticosteroids reduces kidney scarring in children radiologically confirmed to have extensive pyelonephritis. Efficacy of corticosteroids for children with febrile urinary tract infection (UTI) has not been studied. Methods Children aged 2 months to 6 years with their first febrile UTI were randomized to corticosteroids or placebo for 3 days (both arms received antimicrobial therapy); kidney scarring was assessed using 99m Tc-dimercaptosuccinic acid kidney scan 5–24 months after the initial UTI. Results We randomized 546 children of which 385 had a UTI and 254 had outcome kidney scans (instead of the 320 planned). Rates of kidney scarring were 9.8% (12/123) and 16.8% (22/131) in the corticosteroid and placebo groups, respectively ( p  = 0.16), corresponding to an absolute risk reduction of 5.9% (95% confidence interval: − 2.2, 14.1). Conclusion While children randomized to adjuvant corticosteroids tended to develop fewer kidney scars than children who were randomized to receive placebo, a statistically significant difference was not achieved. However, the study was limited by not reaching its intended sample size. Clinical Trial Registration Clinicaltrials.gov , NCT01391793, Registered 7/12/2011 Graphical abstract
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-020-04622-3