Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial.
Adjuvants, Pharmaceutic
/ administration & dosage
Adrenal Cortex Hormones
/ administration & dosage
Age Factors
Anti-Bacterial Agents
/ therapeutic use
Child, Preschool
Double-Blind Method
Female
Fever
Glomerulonephritis
/ diagnostic imaging
Humans
Infant
Male
Urinary Tract Infections
/ drug therapy
Children
Clinical trials
DMSA
Dexamethasone
Kidneys
Pyelonephritis
UTI
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
24
03
2020
accepted:
19
05
2020
revised:
15
05
2020
pubmed:
20
6
2020
medline:
21
7
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
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. 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 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). 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. Clinicaltrials.gov , NCT01391793, Registered 7/12/2011 Graphical abstract.
Sections du résumé
BACKGROUND
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
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.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov , NCT01391793, Registered 7/12/2011 Graphical abstract.
Identifiants
pubmed: 32556960
doi: 10.1007/s00467-020-04622-3
pii: 10.1007/s00467-020-04622-3
pmc: PMC7529851
mid: NIHMS1605087
doi:
Substances chimiques
Adjuvants, Pharmaceutic
0
Adrenal Cortex Hormones
0
Anti-Bacterial Agents
0
Banques de données
ClinicalTrials.gov
['NCT01391793']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2113-2120Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK087870
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01DK087870
Pays : United States
Commentaires et corrections
Type : CommentIn
Références
Ren Fail. 1993;15(5):567-71
pubmed: 8290701
Pediatr Nephrol. 1996 Apr;10(2):139-42
pubmed: 8703696
J Urol. 2000 Sep;164(3 Pt 2):1011-5
pubmed: 10958730
Pediatrics. 2010 Dec;126(6):1084-91
pubmed: 21059720
J Urol. 1983 Jan;129(1):193-6
pubmed: 6338249
N Engl J Med. 2018 Feb 1;378(5):428-438
pubmed: 29385364
Infect Immun. 1989 Jul;57(7):2196-202
pubmed: 2543635
JAMA Pediatr. 2014 Oct;168(10):893-900
pubmed: 25089634
J Infect Dis. 1982 Aug;146(2):220-6
pubmed: 7108272
JAMA Pediatr. 2019 Aug 5;:
pubmed: 31381021
BMJ. 1989 Sep 16;299(6701):703-6
pubmed: 2508881
J Urol. 1982 Dec;128(6):1394-400
pubmed: 6759691
JAMA Pediatr. 2016 Sep 1;170(9):848-54
pubmed: 27455161
Exp Mol Pathol. 1981 Feb;34(1):34-42
pubmed: 7007069
Pediatrics. 2011 Sep;128(3):e496-504
pubmed: 21844061
J Urol. 1994 Apr;151(4):1078-80
pubmed: 8126797
Arch Pediatr Adolesc Med. 2000 Apr;154(4):339-45
pubmed: 10768669
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):273-5
pubmed: 15735478
J Urol. 1999 Sep;162(3 Pt 1):815-20
pubmed: 10458387
J Pediatr. 2019 Feb;205:126-129
pubmed: 30340935
J Clin Invest. 1978 Feb;61(2):403-7
pubmed: 621280
J Hypertens. 2000 Apr;18(4):485-91
pubmed: 10779101
Pediatrics. 1999 Jul;104(1 Pt 1):79-86
pubmed: 10390264
J Urol. 1999 Oct;162(4):1396-8
pubmed: 10492222
Pediatrics. 2008 Dec;122 Suppl 5:S240-50
pubmed: 19018048