ADJUNCTIVE ORAL CORTICOSTEROIDS REDUCE RENAL SCARRING: THE PIGLET MODEL OF REFLUX AND ACUTE EXPERIMENTAL PYELONEPHRITIS

AbstractPurpose: We investigate the efficacy of antibiotics combined with corticosteroid in diminishing post-pyelonephritic renal scarring compared to standard antibiotic therapy.Materials and Methods: Bilateral vesicoureteral reflux was surgically created in 36 piglets (72 kidneys). A week later each bladder was inoculated by percutaneous injection with a standardized broth culture of Escherichia coli and molten paraffin.99m Technetium dimercapto-succinic acid (DMSA) scintigraphy was performed 3 days after introduction of urinary infection to detect the presence of acute pyelonephritis. Acute pyelonephritic lesions seen on DMSA scans were graded according to the percentage of renal zone involvement as grade 1-less than 33%, grade 2-33 to 66% and grade 3-greater than 66% involved. When pyelonephritis was present, piglets were randomized to receive either standard antibiotics or antibiotics and 2 mg./kg. prednisolone daily.99m Technetium-DMSA scintigraphy was repeated 2 months after completion of therapy, ...