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Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial
BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children. METHODS: M...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307518/ https://www.ncbi.nlm.nih.gov/pubmed/35041042 http://dx.doi.org/10.1007/s00467-021-05398-w |
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author | Rius-Gordillo, Neus Ferré, Natàlia González, Juan David Ibars, Zaira Parada-Ricart, Ester Fraga, Maria Gloria Chocron, Sara Samper, Manuel Vicente, Carmen Fuertes, Jordi Escribano, Joaquín |
author_facet | Rius-Gordillo, Neus Ferré, Natàlia González, Juan David Ibars, Zaira Parada-Ricart, Ester Fraga, Maria Gloria Chocron, Sara Samper, Manuel Vicente, Carmen Fuertes, Jordi Escribano, Joaquín |
author_sort | Rius-Gordillo, Neus |
collection | PubMed |
description | BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children. METHODS: Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed. RESULTS: Ninety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect. CONCLUSION: Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. GRAPHICAL ABSTRACT: “A higher resolution version of the Graphical abstract is available as Supplementary information.” [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00467-021-05398-w. |
format | Online Article Text |
id | pubmed-9307518 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-93075182022-07-24 Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial Rius-Gordillo, Neus Ferré, Natàlia González, Juan David Ibars, Zaira Parada-Ricart, Ester Fraga, Maria Gloria Chocron, Sara Samper, Manuel Vicente, Carmen Fuertes, Jordi Escribano, Joaquín Pediatr Nephrol Original Article BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children. METHODS: Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed. RESULTS: Ninety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect. CONCLUSION: Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. GRAPHICAL ABSTRACT: “A higher resolution version of the Graphical abstract is available as Supplementary information.” [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00467-021-05398-w. Springer Berlin Heidelberg 2022-01-18 2022 /pmc/articles/PMC9307518/ /pubmed/35041042 http://dx.doi.org/10.1007/s00467-021-05398-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Rius-Gordillo, Neus Ferré, Natàlia González, Juan David Ibars, Zaira Parada-Ricart, Ester Fraga, Maria Gloria Chocron, Sara Samper, Manuel Vicente, Carmen Fuertes, Jordi Escribano, Joaquín Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title | Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title_full | Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title_fullStr | Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title_full_unstemmed | Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title_short | Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
title_sort | dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9307518/ https://www.ncbi.nlm.nih.gov/pubmed/35041042 http://dx.doi.org/10.1007/s00467-021-05398-w |
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