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Randomized Controlled Trial
. 2022 Sep;37(9):2109-2118.
doi: 10.1007/s00467-021-05398-w. Epub 2022 Jan 18.

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

Neus Rius-Gordillo  1   2   3 , Natàlia Ferré  1   3 , Juan David González  4 , Zaira Ibars  5 , Ester Parada-Ricart  2   3   6 , Maria Gloria Fraga  7 , Sara Chocron  8 , Manuel Samper  9 , Carmen Vicente  10 , Jordi Fuertes  11 , Joaquín Escribano  12   13   14   15 ; DEXCAR Study Group
Affiliations
Randomized Controlled Trial

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

Neus Rius-Gordillo et al. Pediatr Nephrol. 2022 Sep.

Abstract

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children.

Methods: Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed.

Results: Ninety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect.

Conclusion: Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation.

Trial registration: Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. "A higher resolution version of the Graphical abstract is available as Supplementary information."

Keywords: Acute pyelonephritis; Children; Corticosteroids; Kidney scar.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart
Fig. 2
Fig. 2
Kidney scar development and severity according to treatment group
See this image and copyright information in PMC

References

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