University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
Pediatr Nephrol. 2020 Nov;35(11):2113-2120. doi: 10.1007/s00467-020-04622-3. Epub 2020 Jun 15.
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 Tc-dimercaptosuccinic acid kidney scan 5-24 months after the initial UTI.
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.
评估辅助全身皮质类固醇治疗减少肾脏瘢痕的疗效。先前的研究表明，辅助使用全身皮质类固醇可减少经影像学证实广泛肾盂肾炎的儿童的肾脏瘢痕形成。皮质类固醇对发热性尿路感染（UTI）患儿的疗效尚未研究。
2 个月至 6 岁的首次发热性 UTI 患儿随机分为皮质类固醇或安慰剂组，接受 3 天治疗（两组均接受抗生素治疗）；初始 UTI 后 5-24 个月，使用 Tc-二巯丁二酸肾脏扫描评估肾脏瘢痕形成。
我们随机分配了 546 名儿童，其中 385 名患有 UTI，254 名进行了肾脏扫描（而不是计划的 320 名）。皮质类固醇组和安慰剂组的肾脏瘢痕形成率分别为 9.8%（12/123）和 16.8%（22/131）（p=0.16），绝对风险降低 5.9%（95%置信区间：-2.2，14.1）。
尽管随机接受辅助皮质类固醇治疗的儿童比随机接受安慰剂治疗的儿童发生肾脏瘢痕的可能性更小，但未达到统计学显著差异。然而，该研究受到未达到预期样本量的限制。
Clinicaltrials.gov，NCT01391793，于 2011 年 7 月 12 日注册
