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Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review
BACKGROUND: Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus and coagulase-negative strains. The risk of vancomycin-induced acute kidney injury increases with plasma vancomycin levels. Vancomycin-induced acute kidney injury is histologically characterized by ac...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872390/ https://www.ncbi.nlm.nih.gov/pubmed/29587650 http://dx.doi.org/10.1186/s12882-018-0845-1 |
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author | Sawada, Anri Kawanishi, Kunio Morikawa, Shohei Nakano, Toshihiro Kodama, Mio Mitobe, Mitihiro Taneda, Sekiko Koike, Junki Ohara, Mamiko Nagashima, Yoji Nitta, Kosaku Mochizuki, Takahiro |
author_facet | Sawada, Anri Kawanishi, Kunio Morikawa, Shohei Nakano, Toshihiro Kodama, Mio Mitobe, Mitihiro Taneda, Sekiko Koike, Junki Ohara, Mamiko Nagashima, Yoji Nitta, Kosaku Mochizuki, Takahiro |
author_sort | Sawada, Anri |
collection | PubMed |
description | BACKGROUND: Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus and coagulase-negative strains. The risk of vancomycin-induced acute kidney injury increases with plasma vancomycin levels. Vancomycin-induced acute kidney injury is histologically characterized by acute interstitial nephritis and/or acute tubular necrosis. However, only 12 biopsy-proven cases of vancomycin-induced acute kidney injury have been reported so far, as renal biopsy is rarely performed for such cases. Current recommendations for the prevention or treatment of vancomycin-induced acute kidney injury are drug monitoring of plasma vancomycin levels using trough level and drug withdrawal. Oral prednisone and high-flux haemodialysis have led to the successful recovery of renal function in some biopsy-proven cases. CASE PRESENTATION: We present the case of a 41-year-old man with type 1 diabetes mellitus, who developed vancomycin-induced acute kidney injury during treatment for Fournier gangrene. His serum creatinine level increased to 1020.1 μmol/L from a baseline of 79.6 μmol/L, and his plasma trough level of vancomycin peaked at 80.48 μg/mL. Vancomycin discontinuation and frequent haemodialysis with high-flux membrane were immediately performed following diagnosis. Renal biopsy showed acute tubular necrosis and focal acute interstitial nephritis, mainly in the medullary rays (medullary ray injury). There was no sign of glomerulonephritis, but mild diabetic changes were detected. He was discharged without continuing haemodialysis (serum creatinine level, 145.0 μmol/L) 49 days after initial vancomycin administration. CONCLUSIONS: This case suggests that frequent haemodialysis and renal biopsy could be useful for the treatment and assessment of vancomycin-induced acute kidney injury, particularly in high-risk cases or patients with other renal disorders. |
format | Online Article Text |
id | pubmed-5872390 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58723902018-04-02 Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review Sawada, Anri Kawanishi, Kunio Morikawa, Shohei Nakano, Toshihiro Kodama, Mio Mitobe, Mitihiro Taneda, Sekiko Koike, Junki Ohara, Mamiko Nagashima, Yoji Nitta, Kosaku Mochizuki, Takahiro BMC Nephrol Case Report BACKGROUND: Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus and coagulase-negative strains. The risk of vancomycin-induced acute kidney injury increases with plasma vancomycin levels. Vancomycin-induced acute kidney injury is histologically characterized by acute interstitial nephritis and/or acute tubular necrosis. However, only 12 biopsy-proven cases of vancomycin-induced acute kidney injury have been reported so far, as renal biopsy is rarely performed for such cases. Current recommendations for the prevention or treatment of vancomycin-induced acute kidney injury are drug monitoring of plasma vancomycin levels using trough level and drug withdrawal. Oral prednisone and high-flux haemodialysis have led to the successful recovery of renal function in some biopsy-proven cases. CASE PRESENTATION: We present the case of a 41-year-old man with type 1 diabetes mellitus, who developed vancomycin-induced acute kidney injury during treatment for Fournier gangrene. His serum creatinine level increased to 1020.1 μmol/L from a baseline of 79.6 μmol/L, and his plasma trough level of vancomycin peaked at 80.48 μg/mL. Vancomycin discontinuation and frequent haemodialysis with high-flux membrane were immediately performed following diagnosis. Renal biopsy showed acute tubular necrosis and focal acute interstitial nephritis, mainly in the medullary rays (medullary ray injury). There was no sign of glomerulonephritis, but mild diabetic changes were detected. He was discharged without continuing haemodialysis (serum creatinine level, 145.0 μmol/L) 49 days after initial vancomycin administration. CONCLUSIONS: This case suggests that frequent haemodialysis and renal biopsy could be useful for the treatment and assessment of vancomycin-induced acute kidney injury, particularly in high-risk cases or patients with other renal disorders. BioMed Central 2018-03-27 /pmc/articles/PMC5872390/ /pubmed/29587650 http://dx.doi.org/10.1186/s12882-018-0845-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Sawada, Anri Kawanishi, Kunio Morikawa, Shohei Nakano, Toshihiro Kodama, Mio Mitobe, Mitihiro Taneda, Sekiko Koike, Junki Ohara, Mamiko Nagashima, Yoji Nitta, Kosaku Mochizuki, Takahiro Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title | Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title_full | Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title_fullStr | Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title_full_unstemmed | Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title_short | Biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
title_sort | biopsy-proven vancomycin-induced acute kidney injury: a case report and literature review |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872390/ https://www.ncbi.nlm.nih.gov/pubmed/29587650 http://dx.doi.org/10.1186/s12882-018-0845-1 |
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