Abstract
Acute renal failure in children treated with vancomycin typically presents with interstitial nephritis. There is debate as to the extent of direct tubular toxicity attributable to vancomycin, especially in the absence of aminoglycoside treatment. We report a case of acute tubular necrosis (ATN) associated with vancomycin toxicity in an 8-year-old boy where there is no likely alternate explanation for toxic or ischemic injury. Treatment with hemodialysis resulted in the elimination of vancomycin from the circulation and subsequent improvement in renal function.
References
Codding CE, Ramseyer L, Allon M, Pitha J, Rodriguez M (1989) Tubulointerstitial nephritis due to vancomycin. Am J Kidney Dis 14:512–515
Elting LS, Rubenstein EB, Kurtin D, Rolston KV, Fangtang J, Martin CG, Raad II, Whimbey EE, Manzullo E, Bodey GP (1998) Mississippi mud in the 1990s: risks and outcomes of vancomycin-associated toxicity in general oncology practice. Cancer 83:2597–2607
Panzarino VM, Feldstein TJ, Kashtan CE (1998) Charcoal hemoperfusion in a child with vancomycin overdose and chronic renal failure. Pediatr Nephrol 12:63–64
Pauly DJ, Musa DM, Lestico MR, Lindstrom MJ, Hetsko CM (1990) Risk of nephrotoxicity with combination vancomycin-aminoglycoside antibiotic therapy. Pharmacotherapy 10:378–382
Sokol H, Vigneau C, Maury E, Guidet B, Offenstadt G (2004) Biopsy-proven anuric acute tubular necrosis associated with vancomycin and one dose of aminoside. Nephrol Dial Transplant 19:1921–1922
Walczyk MH, Hill D, Arai A, Wolfson M (1988) Acute renal failure owing to inadvertent vancomycin overdose. Vancomycin removal by continuous arteriovenous hemofiltration. Ann Clin Lab Sci 18:440–443
Zimmermann AE, Katona BG, Plaisance KI (1995) Association of vancomycin serum concentrations with outcomes in patients with gram-positive bacteremia. Pharmacotherapy 15:85–91
King DW, Smith MA (2004) Proliferative responses observed following vancomycin treatment in renal proximal tubule epithelial cells. Toxicol In Vitro 18:797–803
Nishino Y, Takemura S, Minamiyama Y, Hirohashi K, Ogino T, Inoue M, Okada S, Kinoshita H (2003) Targeting superoxide dismutase to renal proximal tubule cells attenuates vancomycin-induced nephrotoxicity in rats. Free Radic Res 37:373–379
Toyoguchi T, Takahashi S, Hosoya J, Nakagawa Y, Watanabe H (1997) Nephrotoxicity of vancomycin and drug interaction study with cilastatin in rabbits. Antimicrob Agents Chemother 41:1985–1990
Kropp H, Kahan FM, MacDonald JS, Birnbaum J (1986) Imipenem-cilastatin. In: Sherry F, Queener J, Webber A, Stephen W (eds) Beta-lactam antibiotics for clinical use. Marcel Dekker, New York, pp 177–182
Öktem F, Arslan MK, Ozguner F, Candir Ö, Yilmaz HR, Ciris M, Uz E (2005) In vivo evidences suggesting the role of oxidative stress in pathogenesis of vancomycin-induced nephrotoxicity: protection by erdosteine. Toxicology 215:227–233
Fiaccadori E, Maggiore U, Arisi A, Cabassi A, Beghi C, Campodonico R, Gherli T (2001) Outbreak of acute renal failure due to cefodizime-vancomycin association in a heart surgery unit. Intensive Care Med 27:1819–1822
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wicklow, B.A., Ogborn, M.R., Gibson, I.W. et al. Biopsy-proven acute tubular necrosis in a child attributed to vancomycin intoxication. Pediatr Nephrol 21, 1194–1196 (2006). https://doi.org/10.1007/s00467-006-0152-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-006-0152-0