Dexametasona en la prevenció del dany renal en el primer episodi d'infecció del tracte urinari febril (DEXCAR)

Identificador:  TDX:4411

Handle: https://hdl.handle.net/20.500.11797/TDX4411

Autors:  Rius Gordillo, Neus

Resum:
Introduction: It is postulated that the pathogenesis of the appearance of renal scar after APN is related to the inflammatory and immunological cascade produced to eradicate the bacteria, with the formation of scar tissue at the site of infection. The objective of our study is to evaluate the effect of adjuvant treatment with dexamethasone in reducing the risk of renal scarring after APN in childhood, as well as to evaluate the effect of corticosteroid treatment on the decrease in inflammatory cytokines and other urinary biomarkers. Methodology: DEXCAR study is a randomized, multicenter, prospective, double-blind, placebo-controlled clinical trial in children 1 month to 14 years with APN, randomly assigned to receive a 3-day adjuvant treatment with intravenous dexamethasone (0.30 mg/day twicely) or placebo. Analysis, renovesical ultrasound, DMSA and VCUG are performed. A urine sample is collected at diagnosis and 72 hours later for the study of urinary biomarkers. The presence of renal scar is evaluated with DMSA 6 months after APN. Results: Of the 116 cases with APN, 91 completed follow-up (49 dexamethasone group and 42 placebo). 22% (20 children) had kidney scarring, with no significant differences between both treatment groups (22% and 21% in dexamethasone and placebo respectively, p=0.907). Severe APN (REDSS ≥3) and elevated procalcitonin modulated the risk of developing kidney scar (β=0.648, p=0.023 in REDSS≥3; β=0.065 p=0.027 in PCT). The presence of VUR showed a trend (β = 0.545, p = 0.054). A subanalysis of 92 patients with APN and a study of urine biomarkers shows that severe APN (REDSS ≥3) presents higher concentrations of TNFα (81.0 ± 75.8 vs. 33.6 ± 48.5 pg/ mg creatinine, p=0.015) and those with VUR have higher concentrations of KIM1 (7.87 ± 4.78 vs. 4.68 ± 2.95 ng/mg creatinine, p=0.029). After 72 hours, a decrease in urinary biomarkers is observed, regardless of the treatment received. Conclusions: Administration of dexamethasone in patients with APN does not reduce the risk of kidney scar formation in children nor does it modulate the urinary concentration of cytokines and other biomarkers.