Nader Shaikh1,2, Timothy R Shope3,4, Alejandro Hoberman3,4, Gysella B Muniz3,4, Sonika Bhatnagar3,4, Andrew Nowalk3,4, Robert W Hickey3,4, Marian G Michaels3,4, Diana Kearney3, Howard E Rockette5, Martin Charron6, Ruth Lim7, Massoud Majd8, Eglal Shalaby-Rana8, Marcia Kurs-Lasky3, Daniel M Cohen9, Ellen R Wald10, Greg Lockhart11, Hans G Pohl8, Judith M Martin3,4. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. nader.shaikh@chp.edu. 2. Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. nader.shaikh@chp.edu. 3. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 4. Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. 5. Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 6. Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA. 7. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 8. Children's National Health System, Washington, DC, USA. 9. Nationwide Children's Hospital, Columbus, OH, USA. 10. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 11. Hasbro Children's Hospital, Alpert Medical School, Providence, RI, USA.
Abstract
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 99mTc-dimercaptosuccinic acid kidney scan 5-24 months after the initial UTI. 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.
RCT Entities:
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 99mTc-dimercaptosuccinic acid kidney scan 5-24 months after the initial UTI. 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.
Entities:
Keywords:
Children; Clinical trials; DMSA; Dexamethasone; Kidneys; Pyelonephritis; UTI
Authors: Nader Shaikh; Jonathan C Craig; Maroeska M Rovers; Liviana Da Dalt; Stefanos Gardikis; Alejandro Hoberman; Giovanni Montini; Carlos Rodrigo; Seppo Taskinen; David Tuerlinckx; Timothy Shope Journal: JAMA Pediatr Date: 2014-10 Impact factor: 16.193
Authors: Danila Azzolina; Giulia Lorenzoni; Silvia Bressan; Liviana Da Dalt; Ileana Baldi; Dario Gregori Journal: Int J Environ Res Public Health Date: 2021-02-21 Impact factor: 3.390
Authors: Christopher W Marshall; Marcia Kurs-Lasky; Christi L McElheny; Sophia Bridwell; Hui Liu; Nader Shaikh Journal: Microbiol Spectr Date: 2021-12-22