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.

中文翻译：

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用于预防发热性尿路感染儿童肾脏瘢痕形成的皮质类固醇：一项随机试验。

背景 评估辅助全身皮质类固醇在减少肾脏瘢痕形成方面的功效。先前的一项研究表明，在放射学证实患有广泛性肾盂肾炎的儿童中，使用辅助全身皮质类固醇可减少肾脏瘢痕形成。尚未研究皮质类固醇对发热性尿路感染 (UTI) 儿童的疗效。方法 将 2 个月至 6 岁首次出现发热性 UTI 的儿童随机分配至皮质类固醇或安慰剂组 3 天（两组均接受抗菌治疗）；在初始 UTI 后 5-24 个月，使用 99mTc-二巯基琥珀酸肾脏扫描评估肾脏瘢痕形成。结果 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）。肾脏瘢痕形成率分别为 9.8% (12/123) 和 16%。皮质类固醇和安慰剂组分别为 8% (22/131) (p = 0.16)，对应于 5.9% 的绝对风险降低（95% 置信区间：- 2.2, 14.1）。结论 虽然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往往出现较少的肾脏瘢痕，但未达到统计学上的显着差异。然而，该研究因未达到其预期样本量而受到限制。临床试验注册 Clinicaltrials.gov，NCT01391793，注册于 7/12/2011 图形摘要。结论 虽然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往往出现较少的肾脏瘢痕，但未达到统计学上的显着差异。然而，该研究因未达到其预期样本量而受到限制。临床试验注册 Clinicaltrials.gov，NCT01391793，注册于 7/12/2011 图形摘要。结论 虽然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往往出现较少的肾脏瘢痕，但未达到统计学上的显着差异。然而，该研究因未达到其预期样本量而受到限制。临床试验注册 Clinicaltrials.gov，NCT01391793，注册于 7/12/2011 图形摘要。