According to recent research published in the BMJ Journals, researchers have observed that duration 'adjuvant corticosteroid therapy' along with routine antibiotic therapy in acute febrile urinary tract infection significantly reduces the risk of kidney scarring.
Acute pyelonephritis in children may result in permanent kidney scarring that is primarily caused by inflammation during acute infection. Antibiotic therapy alone is not enough to significantly reduce kidney scarring, and adjuvant corticosteroid therapy has shown a significant reduction in inflammatory cytokines in urine prompting its evaluation in randomised controlled trials. A few clinical trials showed a trend towards a reduction in renal scarring but did not have an adequate sample size to show a significant effect.
Hence, Jitendra Meena and colleagues from the Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India conducted this study to synthesise the available evidence on the role of corticosteroids as adjuvant therapy in reducing kidney scarring.
Their main objective was to assess the efficacy and safety of adjuvant corticosteroid therapy for the prevention of kidney scarring in children with acute pyelonephritis.
The authors included a total of 529 children less than 18 years with acute pyelonephritis. The primary outcome was measured to evaluate the efficacy in preventing kidney scarring while the secondary outcome analyzed the serious adverse events associated with corticosteroid therapy.
The following results were seen-
a. Corticosteroids are effective in lowering the risk of kidney scarring as compared with placebo (risk ratio (RR): 0.57; 95% CI 0.36 to 0.90).
b. No significant increase risk of bacteraemia (RR: 1.38; 95% CI 0.23 to 8.23) and hospitalisation (RR: 0.87; 95% CI 0.3 to 2.55) was observed in corticosteroid group.
Therefore, the authors concluded that "short duration 'adjuvant corticosteroid therapy' along with routine antibiotic therapy in acute febrile urinary tract infection significantly reduces the risk of kidney scarring without any significant adverse effects."