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The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials

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Abstract

Background

Renal scarring after acute pyelonephritis (APN) in children is of concern and in the worst cases leads to long-term cardiovascular morbidity. There are reports that vitamin A may alleviate renal damage following APN. We conducted a meta-analysis to investigate the role of vitamin A in the alleviation of renal damage.

Methods

We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials (CENTRAL, the Cochrane Library) and the Wang Fang database (Chinese) from their inception to February 3, 2015 for randomized controlled trials (RCTs) investigating vitamin A and renal damage. Primary outcome was number of patients/kidneys with renal damage, defined as persistence of photopenic lesions based on technetium-99m dimercaptosuccinic acid renal scintigraphy. We calculated pooled relative risks for renal damage in the vitamin A group.

Results

Four RCTs, involving a total of 248 patients aged 1–144 months (120 in experimental group, 128 in control group), were included in the meta-analysis. Vitamin A was inversely associated with renal damage (relative risk 0.53, 95 % confidence interval 0.43, 0.67) when compared with placebo group after an average follow-up of 5 months.

Conclusions

Current evidence indicates that vitamin A may exert a preventive effect on renal damage in children with APN. However, this finding largely relies on a few studies of low methodological quality, i.e., high risk of selection bias, performance bias and attrition bias. Hence, high-quality and adequately powered RCTs are warranted.

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References

  1. Coulthard MG, Lambert HJ, Keir MJ (1997) Occurrence of renal scars in children after their first referral for urinary tract infection. BMJ 315:918–919

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Lin KY, Chiu NT, Chen MJ, Lai CH, Huang JJ, Wang YT, Chiou YY (2003) Acute pyelonephritis and sequelae of renal scar in pediatric first febrile urinary tract infection. Pediatr Nephrol 18:362–365

    PubMed  Google Scholar 

  3. Dick PT, Feldman W (1996) Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr 128:15–22

    Article  CAS  PubMed  Google Scholar 

  4. Glauser MP, Meylan P, Bille J (1987) The inflammatory response and tissue damage. The example of renal scars following acute renal infection. Pediatr Nephrol 1:615–622

    Article  CAS  PubMed  Google Scholar 

  5. Shimamura T (1981) Mechanisms of renal tissue destruction in an experimental acute pyelonephritis. Exp Mol Pathol 34:34–42

    Article  CAS  PubMed  Google Scholar 

  6. Glauser MP, Lyons JM, Braude AI (1978) Prevention of chronic experimental pyelonephritis by suppression of acute suppuration. J Clin Invest 61:403–407

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Koyle MA, Elder JS, Skoog SJ, Mattoo TK, Pohl HG, Reddy PP, Abidari JM, Snodgrass WT (2011) Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int 27:337–346

    Article  PubMed  Google Scholar 

  8. Rudaitis S, Pundziene B, Jievaltas M, Uktveris R, Kevelaitis E (2009) Recurrent urinary tract infection in girls: do urodynamic, behavioral and functional abnormalities play a role? J Nephrol 22:766–773

    PubMed  Google Scholar 

  9. Johnson JR, Roberts PL, Stamm WE (1987) P fimbriae and other virulence factors in Escherichia coli urosepsis: association with patients' characteristics. J Infect Dis 156:225–229

  10. Ragnarsdottir B, Svanborg C (2012) Susceptibility to acute pyelonephritis or asymptomatic bacteriuria: host–pathogen interaction in urinary tract infections. Pediatr Nephrol 27:2017–2029

    Article  PubMed  Google Scholar 

  11. Haraoka M, Matsumoto T, Mizunoe Y, Ogata N, Takahashi K, Kubo S, Tanaka M, Kumazawa J (1993) Effect of prednisolone on renal scarring in rats following infection with Serratia marcescens. Ren Fail 15:567–571

  12. Matsumoto T, Mitzunoe Y, Ogata N, Tanaka M, Takahashi K, Kumazawa J (1992) Antioxidant effect on renal scarring following infection of mannose-sensitive-piliated bacteria. Nephron 60:210–215

    Article  CAS  PubMed  Google Scholar 

  13. Kavukcu S, Soylu A, Turkmen M, Sarioglu S, Buyukgebiz B, Gure A (1999) The role of vitamin A in preventing renal scarring secondary to pyelonephritis. BJU Int 83:1055–1059

    Article  CAS  PubMed  Google Scholar 

  14. Sadeghi Z, Kajbafzadeh AM, Tajik P, Monajemzadeh M, Payabvash S, Elmi A (2008) Vitamin E administration at the onset of fever prevents renal scarring in acute pyelonephritis. Pediatr Nephrol 23:1503–1510

    Article  PubMed  Google Scholar 

  15. Emamghorashi F, Owji SM, Motamedifar M (2011) Evaluation of effectiveness of vitamins C and E on prevention of renal scar due to pyelonephritis in rat. Adv Neurol 2011:489496

    Google Scholar 

  16. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed Central  Google Scholar 

  17. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed Central  PubMed  Google Scholar 

  18. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Potter WZ, Trygstad CW, Helmer OM, Nance WE, Judson WE (1974) Familial hypokalemia associated with renal interstitial fibrosis. Am J Med 57:971–977

    Article  CAS  PubMed  Google Scholar 

  20. Aslan S, Akil I, Aslan G, Onay H, Ozyurt BC, Ozkinay F (2012) Vitamin D receptor gene polymorphism in children with urinary tract infection. Pediatr Nephrol 27:417–421

    Article  PubMed  Google Scholar 

  21. Huang YY, Chen MJ, Chiu NT, Chou HH, Lin KY, Chiou YY (2011) Adjunctive oral methylprednisolone in pediatric acute pyelonephritis alleviates renal scarring. Pediatrics 128:e496–504

    Article  PubMed  Google Scholar 

  22. Payton S (2011) Pediatrics: steroids can reduce renal scarring. Nat Rev Urol 8:589

    Article  PubMed  Google Scholar 

  23. Neveus T (2013) Can postpyelonephritic renal scarring be prevented? Pediatr Nephrol 28:187–190

    Article  PubMed  Google Scholar 

  24. Kavukcu S, Turkmen M, Sevinc N, Soylu A, Derebek E, Buyukgebiz B (1998) Serum vitamin A and beta-carotene concentrations and renal scarring in urinary tract infections. Arch Dis Child 78:271–272

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Dalirani R, Yousefi Zoshk M, Sharifian M, Mohkam M, Karimi A, Fahimzad A, Varzandefar M (2011) Role of vitamin A in preventing renal scarring after acute pyelonephritis. Iran J Kidney Dis 5:320–323

    Google Scholar 

  26. Ayazi P, Moshiri SA, Mahyar A, Moradi M (2011) The effect of vitamin A on renal damage following acute pyelonephritis in children. Eur J Pediatr 170:347–350

    Article  CAS  Google Scholar 

  27. Sobouti B, Hooman N, Movahed M (2013) The effect of vitamin E or vitamin A on the prevention of renal scarring in children with acute pyelonephritis. Pediatr Nephrol 28:277–283

    Article  PubMed  Google Scholar 

  28. Qin DY (2012) Vitamin A decreases renal scarring after acute pyelonephritis. China Health Care and Nutrition Survey 1004-7484 (2012)-06-1215-02. Available from: http://www.cnki.net/KCMS/detail/detail.aspx?QueryID=1&CurRec=1&recid=&filename=ZHBJ201210019&dbname=CJFDN1214&dbcode=CJFT&pr=CJFT2012;CJFU2012;&urlid=&yx=&v=MTY5NDFYMUx1eFlTN0RoMVQzcVRyV00xRnJDVVJMK2ZZK1p1RmlIaFY3clBQeVhKWkxHNEg5UE5yNDlFYllSOGU=

  29. Hewitt IK, Zucchetta P, Rigon L, Maschio F, Molinari PP, Tomasi L, Toffolo A, Pavanello L, Crivellaro C, Bellato S, Montini G (2008) Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics 122:486–490

    Article  PubMed  Google Scholar 

  30. [No authors listed] (1990) Vitamin A and malnutrition/infection complex in developing countries. Lancet 336:1349-1351

  31. Kucuk HF, Bingul SM, Kurt N, Kaptanoglu L, Akyol H, Torlak OA, Colak E (2006) Effect of a selective cyclooxygenase-2 inhibitor on renal scarring. Eur Surg Res 38:451–457

    Article  CAS  PubMed  Google Scholar 

  32. Huang A, Palmer LS, Hom D, Anderson AE, Kushner L, Franco I (1999) Ibuprofen combined with antibiotics suppresses renal scarring due to ascending pyelonephritis in rats. J Urol 162:1396–1398

    Article  CAS  PubMed  Google Scholar 

  33. Haraoka M, Matsumoto T, Mizunoe Y, Takahashi K, Kubo S, Koikawa Y, Tanaka M, Sakamoto Y, Sakumoto M, Nagafuji T, Kumazawa J (1995) Effect of ebselen on renal scarring in rats following renal infection. Chemotherapy 41:208–213

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors’ responsibilities were as follows— G-QZ: study design, literature search, systematic review and data collection, statistical analysis, interpretation of results, and preparation of the manuscript; J-LC: literature search, systematic review and data collection, and statistical analysis; YZ: principal investigator, study design, statistical analysis, and interpretation of results. This study was supported by Chinese Nutrition Society (CNS) Nutrition Research Foundation—DSM Research Fund.

Conflict of interest

None.

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Authors and Affiliations

  1. No. 3 Office of Student Affairs, Chongqing Medical University, Chongqing, China

    Guo-Qiang Zhang

  2. Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Jin-Liang Chen

  3. Department of Nutrition and Food Hygiene, School of Public Health and Management, Chongqing Medical University, #228, No. 1 Yixueyuan Road, Chongqing, 400016, China

    Yong Zhao

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  1. Guo-Qiang Zhang
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Correspondence to Yong Zhao.

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Zhang, GQ., Chen, JL. & Zhao, Y. The effect of vitamin A on renal damage following acute pyelonephritis in children: a meta-analysis of randomized controlled trials. Pediatr Nephrol 31, 373–379 (2016). https://doi.org/10.1007/s00467-015-3098-2

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  • DOI: https://doi.org/10.1007/s00467-015-3098-2

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