Vitamin A for the Prevention of Renal Parenchymal Injury in Children With Acute Pyelonephritis: An assessor-blind Randomized Controlled Trial

Background: To date, limited studies have evaluated the role of vitamin A in acute pyelonephritis (APN). Accordingly, we aimed to investigate the effect of this vitamin on the prevention of renal damage in children with APN. Methods: This assessor-blind randomized controlled trial included ۱۰۸ children with APN, aged ۳ months to ۱۴ years, who were admitted to Bandar Abbas Children’s Hospital, Bandar Abbas, Iran, in ۲۰۲۰. Patients were randomly allocated to two equal groups. Children in the vitamin A group received vitamin A in addition to antibiotics (ceftriaxone), while those in the control group only received antibiotics. Then, children in both groups underwent dimercaptosuccinic acid (DMSA) scanning once at baseline and four months after treatment. Photopenic areas in the DMSA scan were regarded as damaged areas. Further, serum vitamin A levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were measured in all participants before the initiation of treatment. Finally, the demographic features of the participants were noted, including age and gender. Results: Patients in both groups were comparable regarding age and sex. Serum vitamin A levels, CRP, and ESR did not differ significantly between groups before treatment. The mean number of photopenic areas in the baseline DMSA scan was similar in both groups (P = ۰.۴۸۱); however, the mean number of photopenic areas in the DMSA scan after four months was significantly lower in the vitamin A group compared to controls (P = ۰.۰۰۴). Conclusion: Therefore, the use of vitamin A, along with antibiotics can significantly decrease renal damage in children with APN.