Author, as appears in the article.: Rius-Gordillo N; Ferré N; González JD; Ibars Z; Parada-Ricart E; Fraga MG; Chocron S; Samper M; Vicente C; Fuertes J; Escribano J
Department: Medicina i Cirurgia
URV's Author/s: Escribano Subías, Joaquín / Ferre Pallas, Natalia / Parada Ricart, Esther / Rius Gordillo, Neus
Keywords: Urinary-tract-infection Kidney scar Corticosteroids Children Acute pyelonephritis vesicoureteral reflux risk-factors renal scars prevalence metaanalysis kidney scar infants guidelines corticosteroids children ascending pyelonephritis
Abstract: 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.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.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.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.Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. "A higher resolution version of the Graphical abstract is available as Supplementary information."© 2021. The Author(s).
Thematic Areas: Urology & nephrology Saúde coletiva Psicología Pediatrics, perinatology and child health Pediatrics Odontología Nutrição Nephrology Medicina iii Medicina ii Medicina i Matemática / probabilidade e estatística Interdisciplinar General medicine Farmacia Enfermagem Educação física Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Biotecnología
licence for use: https://creativecommons.org/licenses/by/3.0/es/
Author's mail: neus.rius@urv.cat esther.parada@urv.cat neus.rius@urv.cat natalia.ferre@urv.cat joaquin.escribano@urv.cat
Author identifier: 0000-0002-2838-1525 0000-0002-5041-459X
Record's date: 2024-09-07
Papper version: info:eu-repo/semantics/publishedVersion
Link to the original source: https://link.springer.com/article/10.1007/s00467-021-05398-w
Licence document URL: https://repositori.urv.cat/ca/proteccio-de-dades/
Papper original source: Pediatric Nephrology. 37 (9): 2109-2118
APA: Rius-Gordillo N; Ferré N; González JD; Ibars Z; Parada-Ricart E; Fraga MG; Chocron S; Samper M; Vicente C; Fuertes J; Escribano J (2022). Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial. Pediatric Nephrology, 37(9), 2109-2118. DOI: 10.1007/s00467-021-05398-w
Article's DOI: 10.1007/s00467-021-05398-w
Entity: Universitat Rovira i Virgili
Journal publication year: 2022
Publication Type: Journal Publications
Repositori URV