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Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial

Neus Rius-Gordillo1,2,3, Natàlia Ferré1,3, Juan David González4

  • 1Pediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain.

Pediatric Nephrology (Berlin, Germany)
|January 18, 2022
PubMed

Insights

Adjuvant dexamethasone did not reduce kidney scarring in children with acute pyelonephritis (APN). This study found no evidence to recommend corticosteroids for APN treatment in pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Urinary tract infections (UTIs) are common in children and can lead to serious complications.
  • Acute pyelonephritis (APN) is a severe form of UTI that can cause kidney scarring.
  • Kidney scarring in children can have long-term health consequences.

Purpose of the Study:

  • To evaluate the effectiveness of dexamethasone as an adjuvant treatment in preventing kidney scarring after APN in children.
  • To determine if corticosteroid therapy can mitigate long-term renal damage in pediatric APN cases.

Main Methods:

  • A multicenter, prospective, double-blind, placebo-controlled randomized clinical trial (RCT) was conducted.
  • Children aged 1 month to 14 years with confirmed APN received either intravenous dexamethasone or a placebo for 3 days.
  • Kidney scarring was assessed using technetium-99m-dimercaptosuric acid scintigraphy more than 6 months post-APN.

Main Results:

  • Ninety-one children completed the study; 49 received dexamethasone and 42 received placebo.
  • Persistent kidney scarring was observed in 22% of the dexamethasone group and 21% of the placebo group, with no significant difference (p=0.907).
  • Early renal damage severity and procalcitonin levels were significant predictors of scar development, but dexamethasone showed no effect.

Conclusions:

  • Adjuvant dexamethasone treatment did not significantly reduce the incidence of kidney scarring in children with APN.
  • Current evidence does not support the use of adjuvant corticosteroids for treating APN in pediatric patients.
  • Limitations include a smaller-than-predicted sample size and lower-than-expected scar formation rates.
Abstract

Keywords:
Acute pyelonephritisChildrenCorticosteroidsKidney scar

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