The effect of vitamin E or vitamin A on the prevention of renal scarring in children with acute pyelonephritis.
BACKGROUND
Numerous factors may contribute to renal tissue injury after urinary tract infection. We have evaluated the effects of vitamins A or E supplementation in combination with antibiotics for the prevention of renal scarring in acute pyelonephritis.


METHODS
A simple non-blind randomized clinical trial was conducted on 61 children aged 1 month to 10 years between 2004 and 2006. The inclusion criteria were positive urine culture, clinical findings, and 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy-based evidence in favor of acute pyelonephritis. The children were randomized into three treatment groups: 10-day treatment with only antibiotics (control group; n = 25) and 10-day treatment with supplements of vitamin A (n = 17) or vitamin E (n = 18) in addition to antibiotics during the acute phase of infection. The final analysis was performed after excluding male patients. Each patient was evaluated twice by 99mTc-DMSA scintigraphy performed at least 6 months apart. P < 0.05 was considered to be statistically significant.


RESULTS
The analysis included 108 kidney units. The frequency of inflammation at the beginning of therapy was not significantly different in the three groups (63.3 % in vitamin A, 61 % in vitamin E, and 76.2 % in the control group). A worsening of lesions, based on the second 99mTc-DMSA scan, was observed in 42.5, 0, and 23.3 % of the control, vitamin E, and vitamin A patients, respectively (LR = 26.3, P < 0.001).


CONCLUSIONS
Vitamins A or E supplements were effective in reducing renal scarring secondary to acute pyelonephritis.
Pediatric Infectious Disease, Ali-Asghar Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. bsobooti@tums.ac.ir
Behnam
B
Sobouti
Nakysa
N
Hooman
Mansour
M
Movahed
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000473:pathology; D011704:Pyelonephritis / Q000150:complications*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014801:Vitamin A / Q000627:therapeutic use*; D014810:Vitamin E / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000975:Antioxidants; D019275:Radiopharmaceuticals; D014801:Vitamin A; D014810:Vitamin E; D019783:Technetium Tc 99m Dimercaptosuccinic Acid