Ceftriaxone-Associated Nephrolithiasis

Cochat, Pierre; Cochat, N; Jouvenet, M; Floret, D.; Wright, Catherine C.; Martín, Xavier; Vallon, J.J.; David, L

doi:10.1093/ndt/5.11.974

Cited by 39 publications

(35 citation statements)

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“…While various researchers have drawn a connection between high doses (>100 mg/kg daily) during extended treatment periods with the development of urinary stones [1,5,12], this problem also occurs at normal dose levels [6,8]. In agreement with these findings, we failed to show a strong relationship between ceftriaxone dose and the uCa/ Cr.…”

Section: Discussionsupporting

confidence: 81%

“…As an anion, ceftriaxone readily forms an insoluble salt with calcium in a 1:1 molar ratio that is capable of precipitation once the solubility of the salt is exceeded [6,[10][11][12]. These biochemical characteristics of ceftriaxone treatment frequently cause biliary sludge or pseudolithiasis, a well-known side effect in children [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

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Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

et al. 2011

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The administration of ceftriaxone is known to be associated with biliary pseudolithiasis, although the development of urolithiasis has only rarely been reported. We treated a young male with bacterial meningitis complicated by urinary precipitates composed of ceftriaxone-calcium salt, which prompted us to study whether ceftriaxone administration predisposes children to the formation of urinary precipitates. The case-control study reported here included 83 children with bacterial pneumonia aged from 3 months to 8.9 years. The children were divided into one group of 43 children who received ceftriaxone (group A) and a second group of 40 children who received amoxicillin (group B). Paired samples of serum and urine before and after treatment were obtained from the patients in each group. There were no significant differences in demographic characteristics and blood biochemistry between the groups. However, the mean urinary calcium to creatinine ratio (uCa/Cr; mg/mg) was significantly higher in group A patients than in group B patients after treatment (0.19 vs. 0.09, respectively; p < 0.001), and analysis of the paired urine samples revealed that the uCa/Cr significantly increased after treatment only in group A patients(p < 0.001). There was a weak but non-significant relationship between the dose of ceftriaxone and the uCa/Cr in group A (p = 0.10, r = 0.24). Our results are the first to demonstrate that ceftriaxone has the potential to significantly increase urinary excretion of calcium, which may be linked to ceftriaxone-related urolithiasis or sludge. We therefore suggest that it is worthwhile monitoring the uCa/Cr levels in patients on ceftriaxone as they may be at greater risk for developing large stones and renal damage.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

et al. 2011

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“…De Moor et al reported a 7-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis 4 days after initiation of treatment [7]. In Cochat et al's study, urolithiasis was reported in a 13-year-old boy with meningitis following 9 days of ceftriaxone treatment [8]. Prince and Senac described a case of urolithiasis following ceftriaxone treatment for epidural abscess [9], and Grasberger et al reported a 6-year-old girl with acute peritonitis following appendectomy who was treated with ceftriaxone (100 mg/kg/day), amikacin, and metronidazole.…”

Section: Discussionmentioning

confidence: 99%

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

et al. 2007

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Urinary tract calculi have been reported to account for between 1 in 1,000 and 1 in 7,600 hospital admissions in children in the USA. The annual incidence of urolithiasis in patients older than 10 years is 109 per 100,000 of the population in men and 36 per 100,000 of the population in women in Minnesota. The use of various medications is considered to be one of the etiologic factors of nephrolithiasis. Ceftriaxone is a widely used third-generation cephalosporin that is generally considered very safe, but complications such as biliary pseudolithiasis, and rarely, nephrolithiasis have been reported in children. There is limited information about urolithiasis as a side effect of ceftriaxone. The aim of this study was evaluation of the incidence of nephrolithiasis following ceftriaxone therapy in children. This quasi-experimental before and after study was conducted in Mofid Children's Hospital between 2003 and 2005. All patients were treated with 75 mg/kg intravenous ceftriaxone. Diagnosis of pyelonephritis was based on standard criteria. The first renal ultrasonography was performed on the first or second day of admission and was repeated on the last day of treatment. We also evaluated complicated patients for the third time with renal ultrasonography 3 months after treatment. Stone-forming patients underwent metabolic kidney stone risk factor evaluation. We evaluated 284 patients with pyelonephritis, 185 girls and 99 boys. The first ultrasonography was normal in all of our patients. On the second ultrasonography renal stones were reported in 4 out of 284 cases (1.4% and CI=0.96-1.83%). Underlying metabolic risk factors could not be identified in stone-forming patients. Follow-up ultrasonography 3 months later was normal. The results of our study suggest that ceftriaxone-treated patients may be at an increased risk of kidney stone formation. Stones passed spontaneously in all affected patients so the use of this effective drug can be safely continued. Close monitoring of ceftriaxone-treated patients with regard to kidney stone formation is recommended.

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“…They include quinolones such as flumequine, 59 oxolinic acid, 60 ciprofloxacin 61 and norfloxacin, 1 aminopenicillins such as amoxicillin and ampicillin, 6,62 cephalosporins such as ceftriaxone (especially in children), [63][64][65] phenazopyridine, 66 or nitrofurantoin. 67 However, such cases are very infrequent and occurrence of stones in these patients suggests the intervention of favoring factors, such as unusually high daily dose, prolonged administration, and low urine pH, except with regard to fluoroquinolones such as ciprofloxacin or norfloxacin, which rather crystallize in alkaline urine.…”

Section: Other Antibacterial Agentsmentioning

confidence: 99%

Drug-Induced Renal Stones

Daudon

Jungers²

2010

Urinary Tract Stone Disease

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Drug-induced stones represent about 1% of all renal stones. They involve two main mechanisms. The first one includes stones made of the drug and/or its metabolites identified by X-ray diffraction or infrared spectroscopy on the basis of their specific diagrams. Nowadays, the most commonly observed ones are antiproteases (such as indinavir) used in HIV-infected patients, high-dose sulfadiazine used for the treatment of cerebral toxoplasmosis, and abuse of ephedrine/guaifenesin-containing preparations, whereas triamterene, formerly the most often involved drug, is less frequently observed. The second one includes stones of common composition, induced by the metabolic effects of the drug on urinary pH and excretion of calcium, oxalate, phosphate, citrate, uric acid, or other purines. The most frequent causes are unsupervised calcium/vitamin D supplementation and carbonic anhydrase inhibitors, including anticonvulsants (such as topiramate). Incidence of metabolically induced stones is probably underestimated, because they are of apparently usual composition and may reveal long after drug withdrawal. Formation of iatrogenic calculi is favored by high-dose or long-lasting treatments, high renal excretion and low solubility of the drug or its metabolites, low urine output or inadequate urine pH, and is especially frequent in patients with a history of stones. Better awareness of potentially lithogenic drugs may allow more efficient prevention and reduce the incidence of drug-induced nephrolithiasis.

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Ceftriaxone-Associated Nephrolithiasis

Cited by 39 publications

References 0 publications

Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

Drug-Induced Renal Stones

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