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Open Access 21-03-2023 | Vesicorenal Reflux | Systematic Review/Meta-analysis

The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials

Authors: Nikolaos Gkiourtzis, Agni Glava, Maria Moutafi, Theopisti Vasileiadou, Theodora Delaporta, Panagiota Michou, Nikoleta Printza, Kali Makedou, Despoina Tramma

Published in: Pediatric Nephrology | Issue 12/2023

Abstract

Background

Acute pyelonephritis (APN) in pediatric patients may lead to kidney scarring and is one of the main causes of permanent kidney damage. The incidence of kidney scarring after one febrile urinary tract infection (UTI) is reported to range from 2.8 to 15%, with the percentage rising to 28.6% after ≥ 3 febrile UTIs. Corticosteroids may have a role in the reduction of kidney scar formation and urine cytokine levels. The possible benefit of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN has been recently examined in randomized controlled trials (RCTs).

Objectives

The aim of this meta-analysis was to provide a summary of the current literature about the efficacy and safety of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN.

Data sources

An extensive literature search through major databases (PubMed/MEDLINE and Scopus) was carried out for RCTs from inception until October 12, 2022, investigating the efficacy and safety of adjuvant corticosteroids in preventing kidney scarring in children with APN. A risk ratio with 95% CI was used for dichotomous outcomes.

Results

In total, 5 RCTs with 918 pediatric patients with APN were included in the study. Adjuvant corticosteroid treatment revealed a statistically significant reduction in kidney scarring (95% CI 0.42–0.95, p = 0.03), without increasing the risk of adverse events like bacteremia, prolonged hospitalization, or recurrence of UTI.

Limitations

There were limitations regarding sample size (n = 498 children), different classes of corticosteroids (methylprednisolone or dexamethasone), different routes of corticosteroid administration (intravenous or oral), and different day courses (3-day or 4-day course).

Conclusions

Adjuvant corticosteroid administration seems to have a beneficial effect on kidney scar reduction in children with APN. Future studies should focus on the evaluation of the efficacy and safety of corticosteroids in kidney scarring reduction after APN to strengthen the results of our study.

Graphical Abstract

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Title: The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials
Authors: Nikolaos Gkiourtzis
Agni Glava
Maria Moutafi
Theopisti Vasileiadou
Theodora Delaporta
Panagiota Michou
Nikoleta Printza
Kali Makedou
Despoina Tramma
Publication date: 21-03-2023
Publisher: Springer Berlin Heidelberg
Keywords: Vesicorenal Reflux
Pyelonephritis
Urinary Tract Infection
Pyelonephritis
Dexamethasone
Published in: Pediatric Nephrology / Issue 12/2023
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-05922-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials

Abstract

Background

Objectives

Data sources

Results

Limitations

Conclusions

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Data sources

Results

Limitations

Conclusions

Graphical Abstract

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