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Preventive Effect of L-Carnitine on Scar Formation During Acute Pyelonephritis: A Randomized Placebo-Controlled Trial
Alaleh Gheissari1, Nahid Aslani1, Azadeh Eshraghi2
1Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
L-carnitine supplementation significantly reduced kidney scarring in children with acute pyelonephritis. This study highlights L-carnitine
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Medical Research
Background:
- Urinary tract infections (UTIs) and pyelonephritis are common pediatric issues.
- Renal scarring, injury, and morbidity can result from pyelonephritis in children.
- Identifying preventive strategies for renal scarring is crucial.
Purpose of the Study:
- To investigate the potential of L-carnitine in preventing renal scarring.
- To evaluate the efficacy of L-carnitine as an adjunct therapy for acute pyelonephritis in children.
Main Methods:
- A randomized double-blind clinical trial involved 65 children (6 months to 10 years).
- Participants received either antibiotics alone (control) or antibiotics with L-carnitine for 7 days.
- Technetium-99m-labeled dimercaptosuccinic acid (DMSA) scintigraphy assessed kidney scarring during acute and late phases.
Main Results:
- No significant differences in age, sex, blood pressure, or laboratory markers between groups.
- Baseline DMSA scans showed no significant differences.
- Worsening of kidney lesions was significantly higher in the control group (P = 0.012) after 6 months.
Conclusions:
- L-carnitine significantly reduced renal scarring associated with acute pyelonephritis in children.
- L-carnitine demonstrates a protective effect against pyelonephritis-induced kidney damage.
Background:
Urinary tract infection and pyelonephritis are clinical problems that frequently occur in children. Several factors are responsible for renal tissue injury, morbidity, and renal scarring after pyelonephritis. The aim of this study was to evaluate the preventive effect of L-carnitine on renal scarring in acute pyelonephritis.
Methods:
A randomized double-blind clinical trial was conducted on 65 children aged 6 months to 10 years. Patients were randomized into 2 groups to receive 7-day treatment with only antibiotics without L-carnitine (control group; n = 32) and 7-day treatment with L-carnitine (case group; n = 33) during the acute phase of infection. Technetium-99m-labeled dimercaptosuccinic acid (DMSA) scintigraphy was performed for all children during the acute phase (in 2-7 days of hospitalization) and late phase. P-value less than 0.05 was statistically significant.
Results:
We recruited 65 participants in the study: 32 children in control group and 33 children in case group. Three children in the control group and 2 children in the case group refused to perform the second DMSA scan. Overall, data analysis at the end of the study was done on 60 patients. Age distribution of girl patients with upper urinary infection was 6.5% in girl children aged between 6 months and 12 months, 41.1% aged between 1 and 5 years, 33.3% aged between 5 and 10 years, respectively. There was no significant difference between 2 groups in age and sex. There was no significant difference between 2 groups in systolic blood pressure, diastolic blood pressure, the lab data including urine white blood cells and serum erythrocyte sedimentation rate, and antibiogram profiles. Voiding dysfunction was detected in 10% of the participants. The baseline DMSA was not significantly difference in 2 groups, but worsening of kidney lesions was significantly higher in control group after 6 months (P = 0.012).
Conclusion:
Our study showed that L-carnitine significantly decreased renal scarring because of acute pyelonephritis.
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