NEW YORK (Reuters Health) – A short course of methylprednisolone added to antibiotic therapy for acute pyelonephritis in children significantly reduces the development of renal scars, a Taiwanese group reports in the September issue of Pediatrics.
“Adjunctive oral MPD (methylprednisolone) with adequate antibiotics merits further consideration as a potential treatment regimen to alleviate permanent tissue injury in admitted children with serious APN (acute pyelonephritis),” the authors conclude.
Dr. Yuan-Yow Chiou, with the National Cheng Kung University Medical College and Hospital in Tainan City, and colleagues point out that nearly two-thirds of children with febrile urinary tract infections have acute pyelonephritis, and consequent renal scarring can have long-term sequelae – including hypertension, toxemia of pregnancy, and renal failure.
Based on preclinical studies and evidence from the treatment of bacterial meningitis, the team conducted a randomized trial to see if glucocorticoids would ameliorate the destructive inflammatory process in acute pyelonephritis and reduce scarring.
The study involved 84 children diagnosed with their first episode of acute pyelonephritis and who were at high risk of renal scar formation, based on technetium-DMSA scans or ultrasonography findings. All received IV cephalothin and gentamycin every 6 hours for a minimum of 3 days. Additionally, 19 of the patients were also given methylprednisolone (1.6 mg/kg per day, maximum of 48 mg/day) while 65 received placebo.
On follow-up DMSA scans, renal scarring was evident in 33.3% of the methylprednisolone group and in 60.0% of the placebo group. Furthermore, the researchers report, “A significant difference was found between the 2 groups in the maximal photopenic area during the scar-formation stage (median: 0 [range: 0-4.5] vs 1.1 [range: 0-14.8] mL; p<0.05).”
Dr. Chiou and colleagues comment that the incidence of renal scarring in the placebo group was higher than reported in previous studies, and that rates seem to be higher in Asia than elsewhere – although patients in this study were selected because of their high risk for subsequent renal damage.
Overall, they conclude, “This study revealed that the antiinflammatory drug MPD, when combined with antibiotic agents, can ameliorate both clinical parameters and renal scar formation in pediatric patients with APN.”
Reference:
Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring
Pediatrics 2011;128.
