The role of dexamethasone on decreasing urinary cytokines in children with acute pyelonephritis

Abstract

Cytokines play a major role in renal scar formation following febrile urinary tract infection (UTI). We investigated the role of dexamethasone combined with antibiotics in diminishing urinary interleukin-6 (UIL-6) and UIL-8 concentrations during the acute phase of pyelonephritis compared with standard antibiotic therapy. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with pyelonephritis who were treated with ceftriaxone plus dexamethasone (case group) and in 20 patients with the same diagnosis treated with ceftriaxone alone (control group). Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 h after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated to standardize samples. Differences between cytokine/creatinine ratios in initial and follow-up urine samples were significant in the case group (P < 0.001) but not for controls. In addition, combined antibiotic and dexamethasone significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone (P < 0.05). We conclude that dexamethasone combined with antibiotics significantly decreases UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This suggests that the clinical use of corticosteroids may prevent scar formation following febrile UTI.

Evaluation and Comparison of Urinary Cytokines for the Diagnosis of Acute Pyelonephritis

“…They are involved in B cell and T cell proliferation and neutrophil chemoattraction, along with secretion of CRP, immunoglobulins, and acute-phase proteins (2,6,8,10) Clinical manifestations of APN depend on the production of different cytokines, and measurement of urinary ILs seems to be useful for the rapid diagnosis and localization of inflammation within the urinary tract system. Increased urinary IL-1, IL-4, IL-6, and IL-8 concentrations have been reported in children with acute febrile UTIs compared to the healthy children and those with lower UTIs, asymptomatic bacteriuria, and non-renal febrile infections (2,(11)(12)(13)(14)(15).…”

Urinary Ghrelin Concentration in Children With Urinary Tract Infections Before and After Treatment

“…If not diagnosed early and left untreated timely, UTIs can lead to scar formation, hypertension and end stage renal disease (ESRD) (1-7). There have been many efforts to study mediators of inflammation trying to halt deleterious effects of UTI such as scar formation (8)(9)(10)(11).…”

The effect of vitamin A on renal damage following acute pyelonephritis in children

“…Also, in a study by Sharifian et al, it was concluded that the administration of dexamethasone could possibly prevent the formation of kidney scar [21]. Regarding this and comparing the side effects of dexamethasone and vitamin A, again the beneficial effects of vitamin A make this chemical as a valuable drug in treatment of acute pyelonephritis and eventually in prevention of kidney scar formation.…”

“…The majority of these studies used laboratory animal models [3,9,14,18,20], and to our knowledge, only two studies of this kind were performed on children [13,21]. There are other studies in which the effects of pentoxifylline, melatonin, and ebselen on prevention of renal scar were examined, but again all were carried out on animal models [10,11,26].…”

“…In a study performed on children with recurrent UTI, the severity of renal scarring was revealed to have an inverse correlation with the serum vitamin A concentration [13,15]. There are several factors affecting the degree of renal tissue damage such as bacterial colonization, endotoxin production, interleukin, and oxidative effect [3,13,21]. Vitamin A is needed by all epithelial cells of body tissues.…”