Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial
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ORIGINAL ARTICLE
Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial Nader Shaikh 1,2 & Timothy R. Shope 1,2 & Alejandro Hoberman 1,2 & Gysella B. Muniz 1,2 & Sonika Bhatnagar 1,2 & Andrew Nowalk 1,2 & Robert W. Hickey 1,2 & Marian G. Michaels 1,2 & Diana Kearney 1 & Howard E. Rockette 3 & Martin Charron 4 & Ruth Lim 5 & Massoud Majd 6 & Eglal Shalaby-Rana 6 & Marcia Kurs-Lasky 1 & Daniel M. Cohen 7 & Ellen R. Wald 8 & Greg Lockhart 9 & Hans G. Pohl 6 & Judith M. Martin 1,2 Received: 24 March 2020 / Revised: 15 May 2020 / Accepted: 19 May 2020 # IPNA 2020
Abstract 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 99mTc-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 Keywords Children . Pyelonephritis . UTI . Dexamethasone . Clinical trials . DMSA . Kidneys
Key message Corticosteroid administration did not significantly reduce kidney scarring; however, the study was limited by not reaching its intended sample size. What does it add to existing literature 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. What is the impact Rates of kidney scarring were 9.8% (12/123) and 16.8% (22/131) in the corticosteroid and placebo groups, respectively (p = 0.16). While corticosteroid administration did not significantly reduce kidney scarring, the study was limited by not reaching its intended sample size. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04622-3) contains supplementary material, which is available to authorized users. * Nader Shaik
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