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EFFICACY OF STEROIDS IN THE MANAGEMENT OF RENAL COLIC IN SCHOOL GOING CHILDREN: A QUASI-EXPERIMENTAL STUDY
Tariq Ahmad, MBBS, FCPS (Urology), Murad Ali, MBBS,FCPS ( Urology ).
Khyber Teaching Hospital, Peshawar, Pakistan.
BACKGROUND:Renal colic is a common and painful urological emergency in children, usually caused by ureteric obstruction secondary to urinary stones. Standard treatment primarily involves non-steroidal anti-inflammatory drugs (NSAIDs) and opioids for pain control; however, these therapies may be associated with significant adverse effects, including gastrointestinal complications, renal impairment, and opioid-related dependence. Corticosteroids possess potent anti-inflammatory properties that may reduce ureteral edema, improve pain relief, and facilitate spontaneous stone passage. Despite their potential benefits, evidence regarding their efficacy in pediatric renal colic remains limited.This study aimed to assess the effectiveness of corticosteroids as adjunct therapy in reducing pain intensity, decreasing analgesic requirements, and enhancing spontaneous stone expulsion rates in pediatric patients with renal colic caused by ureteric stones ≤6mm.
METHODS:This quasi-experimental study was conducted at the Department of Urology, Khyber Teaching Hospital Peshawar, from June 2024 to June 2025. A total of 121 pediatric patients aged 5-15 years diagnosed with renal colic secondary to ureteric stones ≤6 mm were enrolled. Patients were divided into two groups: the Steroid + Standard Therapy Group (n=61), which received deflazacort (0.9 mg/kg orally once daily for three days) in combination with NSAIDs and hydration therapy, and the Standard Therapy Group (n=60), which received NSAIDs and hydration alone. Baseline demographic and clinical characteristics were comparable between groups. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline, 30 minutes, 1 hour, 3 hours, and 6 hours post-treatment. Additional outcomes included total analgesic requirement, spontaneous stone expulsion rates within two weeks, duration of stone passage, and treatment-related adverse effects. Statistical analysis was performed using independent t-tests and chi-square tests with SPSS version 25, considering p < 0.05 statistically significant
RESULTS:The mean age of participants was 12.5 ± 2.3 years, with males comprising 53% of the cohort. Patients receiving corticosteroids demonstrated significantly greater pain reduction at all assessed time intervals compared to the standard therapy group (p < 0.01). At 6 hours, the mean VAS score was 2.1 ± 0.6 in the corticosteroid group versus 4.3 ± 0.9 in controls. The corticosteroid group also required fewer NSAID doses (1.2 ± 0.5 vs. 2.6 ± 0.8; p < 0.01) and less opioid rescue therapy (13% vs. 32%; p < 0.05). Spontaneous stone expulsion rates were significantly higher among corticosteroid-treated patients (89% vs. 60%; p < 0.01), with shorter mean expulsion times (3.2 ± 1.3 days vs. 5.8 ± 1.5 days; p < 0.01). Mild gastrointestinal discomfort was the most common adverse effect, while transient hyperglycemia occurred in 11% of corticosteroid-treated patients without major clinical consequences.
CONCLUSIONS:Adjunctive corticosteroid therapy significantly improves pain control, reduces analgesic dependence, enhances spontaneous stone expulsion, and shortens stone passage duration in pediatric renal colic patients. Corticosteroids appear to be a safe and effective addition to standard NSAID-based therapy and may help reduce the need for opioids and excessive NSAID exposure. Further large-scale randomized controlled trials are recommended to establish standardized treatment protocols and validate long-term safety and efficacy.
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