Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial
Authors:
Nader Shaikh, Timothy R. Shope, Alejandro Hoberman, Gysella B. Muniz, Sonika Bhatnagar, Andrew Nowalk, Robert W. Hickey, Marian G. Michaels, Diana Kearney, Howard E. Rockette, Martin Charron, Ruth Lim, Massoud Majd, Eglal Shalaby-Rana, Marcia Kurs-Lasky, Daniel M. Cohen, Ellen R. Wald, Greg Lockhart, Hans G. Pohl, Judith M. Martin
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.
Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial
Authors
Nader Shaikh Timothy R. Shope Alejandro Hoberman Gysella B. Muniz Sonika Bhatnagar Andrew Nowalk Robert W. Hickey Marian G. Michaels Diana Kearney Howard E. Rockette Martin Charron Ruth Lim Massoud Majd Eglal Shalaby-Rana Marcia Kurs-Lasky Daniel M. Cohen Ellen R. Wald Greg Lockhart Hans G. Pohl Judith M. Martin