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Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application

Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critic...

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Autores principales: Kan, Wei-Chih, Chen, Yi-Chih, Wu, Vin-Cent, Shiao, Chih-Chung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877514/
https://www.ncbi.nlm.nih.gov/pubmed/35216167
http://dx.doi.org/10.3390/ijms23042052
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author Kan, Wei-Chih
Chen, Yi-Chih
Wu, Vin-Cent
Shiao, Chih-Chung
author_facet Kan, Wei-Chih
Chen, Yi-Chih
Wu, Vin-Cent
Shiao, Chih-Chung
author_sort Kan, Wei-Chih
collection PubMed
description Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critically ill patients. The current review comprehensively summarizes the pathophysiological mechanisms of, biomarkers for, preventive strategies for, and some crucial issues with VA-AKI. The pathological manifestations of VA-AKI include acute tubular necrosis, acute tubulointerstitial nephritis (ATIN), and intratubular crystal obstruction. The proposed pathological mechanisms of VA-AKI include oxidative stress and allergic reactions induced by vancomycin and vancomycin-associated tubular casts. Concomitant administration with other nephrotoxic antibiotics, such as piperacillin–tazobactam, high vancomycin doses, and intermittent infusion strategies compared to the continuous infusion are associated with a higher risk of VA-AKI. Several biomarkers could be applied to predict and diagnose VA-AKI. To date, no promising therapy is available. Oral steroids could be considered for patients with ATIN, whereas hemodialysis might be applied to remove vancomycin from the patient. In the future, disclosing more promising biomarkers that could precisely identify populations susceptible to VA-AKI and detect VA-AKI occurrence early on, and developing pharmacological agents that could prevent or treat VA-AKI, are the keys to improve the prognoses of patients with severe infection who probably need vancomycin therapy.
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spelling pubmed-88775142022-02-26 Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application Kan, Wei-Chih Chen, Yi-Chih Wu, Vin-Cent Shiao, Chih-Chung Int J Mol Sci Review Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critically ill patients. The current review comprehensively summarizes the pathophysiological mechanisms of, biomarkers for, preventive strategies for, and some crucial issues with VA-AKI. The pathological manifestations of VA-AKI include acute tubular necrosis, acute tubulointerstitial nephritis (ATIN), and intratubular crystal obstruction. The proposed pathological mechanisms of VA-AKI include oxidative stress and allergic reactions induced by vancomycin and vancomycin-associated tubular casts. Concomitant administration with other nephrotoxic antibiotics, such as piperacillin–tazobactam, high vancomycin doses, and intermittent infusion strategies compared to the continuous infusion are associated with a higher risk of VA-AKI. Several biomarkers could be applied to predict and diagnose VA-AKI. To date, no promising therapy is available. Oral steroids could be considered for patients with ATIN, whereas hemodialysis might be applied to remove vancomycin from the patient. In the future, disclosing more promising biomarkers that could precisely identify populations susceptible to VA-AKI and detect VA-AKI occurrence early on, and developing pharmacological agents that could prevent or treat VA-AKI, are the keys to improve the prognoses of patients with severe infection who probably need vancomycin therapy. MDPI 2022-02-12 /pmc/articles/PMC8877514/ /pubmed/35216167 http://dx.doi.org/10.3390/ijms23042052 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Kan, Wei-Chih
Chen, Yi-Chih
Wu, Vin-Cent
Shiao, Chih-Chung
Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title_full Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title_fullStr Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title_full_unstemmed Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title_short Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
title_sort vancomycin-associated acute kidney injury: a narrative review from pathophysiology to clinical application
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877514/
https://www.ncbi.nlm.nih.gov/pubmed/35216167
http://dx.doi.org/10.3390/ijms23042052
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