Skip to main content
Log in

Biopsy-proven acute tubular necrosis in a child attributed to vancomycin intoxication

  • Brief Report
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

References

  1. Codding CE, Ramseyer L, Allon M, Pitha J, Rodriguez M (1989) Tubulointerstitial nephritis due to vancomycin. Am J Kidney Dis 14:512–515

    Article  CAS  Google Scholar 

  2. 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

    Article  CAS  Google Scholar 

  3. Panzarino VM, Feldstein TJ, Kashtan CE (1998) Charcoal hemoperfusion in a child with vancomycin overdose and chronic renal failure. Pediatr Nephrol 12:63–64

    Article  CAS  Google Scholar 

  4. Pauly DJ, Musa DM, Lestico MR, Lindstrom MJ, Hetsko CM (1990) Risk of nephrotoxicity with combination vancomycin-aminoglycoside antibiotic therapy. Pharmacotherapy 10:378–382

    CAS  PubMed  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    CAS  PubMed  Google Scholar 

  7. Zimmermann AE, Katona BG, Plaisance KI (1995) Association of vancomycin serum concentrations with outcomes in patients with gram-positive bacteremia. Pharmacotherapy 15:85–91

    CAS  PubMed  Google Scholar 

  8. King DW, Smith MA (2004) Proliferative responses observed following vancomycin treatment in renal proximal tubule epithelial cells. Toxicol In Vitro 18:797–803

    Article  CAS  Google Scholar 

  9. 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

    Article  CAS  Google Scholar 

  10. 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

    Article  CAS  Google Scholar 

  11. 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

    Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tom David Blydt-Hansen.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-006-0152-0

Keywords

Navigation