Ceftriaxone and Acute Renal Failure in Children

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Ceftriaxone at therapeutic doses can lead to renal stone formation. WHAT THIS STUDY ADDS:Renal stone formation with ceftriaxone therapy can result in postrenal acute renal failure in children. The condition can be treated effectively by timely pharmacotherapy or retrograde ureteral catheterization with good prognosis. abstract OBJECTIVE: Our aim was to evaluate the clinical profile, treatment, and outcome of ceftriaxone-associated postrenal acute renal failure (PARF) in children. METHODS:We retrospectively studied 31 consecutive cases from 2003 to 2012 for PARF after ceftriaxone treatment. There was no past history of urolithiasis or nephropathy in these children. RESULTS:The average time of ceftriaxone administration before PARF was 5.2 days. The major symptoms apart from anuria included flank pain (.3 years old, 25/25), excessive crying (,3 years, 6/6), and vomiting (19/33). Ultrasound showed mild hydronephrosis (25/31) and ureteric calculi (11/31). Nine children recovered after 1 to 4 days of pharmacotherapy. Twenty-one children who were resistant to pharmacotherapy underwent retrograde ureteral catheterization. After catheterization of their ureters, normal urine flow was observed, and the symptoms subsided immediately. Catheter insertion failed in 1 child who subsequently underwent 3 sessions of hemodialysis before normal urination was restored. Ceftriaxone was verified to be the main component of the calculi in 4 children by tandem mass spectrometric analysis. The recovery was complete in all cases.CONCLUSIONS: Ceftriaxone therapy in children may cause PARF. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy. Pediatrics 2014;133:e917-e922 Ceftriaxone at therapeutic doses can lead to crystallization in the urine and these crystals adhere to the surface of renal tubular cells. 5 Severe nephrolithiasis can cause postrenal acute renal failure (PARF). To date there are only a few studies reporting on PARF associated with ceftriaxone. [9][10][11] Our aim was to study the clinical features, treatment, and outcome of ceftriaxone-associated PARF in children. METHODSBetween January 1, 2003 and June 30, 2012, of the 127 PARF children admitted to the Pediatric Surgery Department of Tongji Hospital, there were 31 children who had a history of ceftriaxone administration a few days before PARF. These children were identified as subjects for the study. The history of ceftriaxone treatment was verified from patient records in 9 children and reported by parents in the remaining 22 children.The diagnosis of PARF was based on sudden onset of anuria, flank pain, and renal percussion pain associated with elevated serum creatinine and/or serum urea nitrogen in a child who had no past history of urolithiasis. The renal ultrasonography findings included normal-sized kidneys, the presence or absence of hydronephrosis, or ureteric calculi with no renal v...

Ceftriaxone-associated renal toxicity in adults: a case report and recommendations for the management of such cases

“…It is widely used to treat infections in both children and adults. Approximately 33–67% of the ceftriaxone is excreted unchanged in the urine, and it could potentially precipitate with calcium to produce stones which obstruct the ureters . Ceftriaxone‐associated urolithiasis and post‐renal acute renal failure (PARF) in children has been well recognized .…”

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