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Adjunctive oral methylprednisolone in pediatric acute pyelonephritis alleviates renal scarring
Ya-Yun Huang1, Mei-Ju Chen, Nan-Tsing Chiu
1Department of Pediatrics, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
Insights
Methylprednisolone sodium phosphate (MPD) adjunctive therapy significantly reduced renal scarring in children with acute pyelonephritis. This treatment also led to faster fever reduction compared to placebo.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Acute pyelonephritis is a serious kidney infection in children.
- Renal scarring can lead to long-term complications.
- Identifying effective treatments to prevent scarring is crucial.
Purpose of the Study:
- To evaluate the efficacy of glucocorticoids in preventing renal scar formation.
- To assess the impact of methylprednisolone sodium phosphate on acute pyelonephritis outcomes in pediatric patients.
Main Methods:
- A randomized controlled trial involving pediatric patients with high-risk acute pyelonephritis.
- Patients received either antibiotics plus methylprednisolone sodium phosphate (MPD) or antibiotics plus placebo for 3 days.
- Renal scarring was assessed using technetium-99m-labeled dimercaptosuccinic acid scans (DMSA) at 6 months.
Main Results:
- Renal scarring occurred in 33.3% of the MPD group versus 60.0% in the placebo group (P < .05).
- Median cortical defect volumes were significantly lower in the MPD group (0.0 mL) compared to the placebo group (1.5 mL) (P < .01).
- Faster defervescence was observed in patients treated with MPD.
Conclusions:
- Adjunctive oral MPD therapy effectively reduces the occurrence and severity of renal scarring post-acute pyelonephritis.
- MPD is a beneficial addition to antibiotic treatment for high-risk pediatric patients.
- This finding supports the use of glucocorticoids to mitigate long-term kidney damage.
Objective:
To determine if glucocorticoids can prevent renal scar formation after acute pyelonephritis in pediatric patients.
Methods:
Patients younger than 16 years diagnosed with their first episode of acute pyelonephritis with a high risk of renal scar formation (ie, inflammatory volume ≥ 4.6 mL on technetium-99m-labeled dimercaptosuccinic acid scan [DMSA] or abnormal renal ultrasonography results) were randomly assigned to receive either antibiotics plus methylprednisolone sodium phosphate (1.6 mg/kg per day for 3 days [MPD group]) or antibiotics plus placebo (placebo group) every 6 hours for 3 days. Patients were reassessed by using DMSA 6 months after treatment. The primary outcome was the development of renal scars.
Results:
A total of 84 patients were enrolled: 19 in the MPD group and 65 in the placebo group. Patient characteristics were similar between the 2 groups, including the acute inflammatory parameters and the initial DMSA result. Renal scarring was found in 33.3% of children treated with MPD and in 60.0% of those who received placebo (P < .05). The median cortical defect volumes on follow-up DMSA were 0.0 mL (range: 0-4.5 mL) and 1.5 mL (range: 0-14.8 mL) for the MPD and placebo groups, respectively (P < .01). Patients in the MPD group experienced faster defervescence after treatment than the placebo group.
Conclusions:
Adjunctive oral MPD therapy reduced the occurrence and/or severity of renal scarring after acute pyelonephritis in these hospitalized children who had a high risk of renal scar formation.
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