Ceftriaxone Linked to Renal Failure in Children

The antibiotic ceftriaxone, at any dose, is linked to renal stones and pediatric acute renal failure (PARF), according to a study published online on March 24 in the journal Pediatrics.

“Ceftriaxone therapy in children may cause PARF,” the authors note. “Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment for those who fail to respond to pharmacotherapy,” Medscape reports.

Ceftriaxone, commonly used to treat childhood infections, has been linked to biliary pseudolithiasis, nephrolithiasis, and bladder sludge, according to the article. Medscape reports that formation of urine crystals that cling to renal tubular cells was observed during ceftriaxone treatment, with the potential for acute renal failure. Few studies have reported on ceftriaxone-associated PARF.

The researchers looked at 31 cases of PARF after treatment with ceftriaxone from January 1, 2003, to June 30, 2012, at Tongji Hospital, Wuhan, China. Children with no previous history of urinary stones or kidney disease were included. Ceftriaxone treatment was verified from nine patient records and by parent report in 22 children. PARF diagnosis was based on symptoms (sudden onset anuria, flank or renal percussion pain) and laboratory tests (serum creatinine and/or urea nitrogen). Drug treatment included spasmolysis (relaxation of spasms) with anisodamine, alkalization with sodium bicarbonate, antibiotics, albumen, and low-dose dexamethasone.

The mean age of the children was 5.1 years and they had been receiving ceftriaxone, on average, 5.2 days before PARF onset. Predominant symptoms included sudden-onset anuria (absence of urination) for at least 24 hours (31/31), flank pain (>3 years, 25/25), excessive crying (<3 years, 6/6), and/or vomiting (19/31). Ultrasounds showed mild hydronephrosis (buildup of urine in the kidney) in 25 of 31 children and ureteric calculi (urinary stones) in 11 of 31. After one to four days of treatment, nine children recovered. Twenty-one children received retrograde ureteral catheterization, which restored normal urine flow in 20. One child needed three sessions of hemodialysis to restore urination. In stones recovered from four children, analysis revealed the main component to be ceftriaxone. Mean treatment duration was 1.8 days, with a mean anuria period of 3.1 days. Ultimately, all children recovered, Medscape reports.

Dr. Keefe Davis, a pediatric nephrologist at Washington University School of Medicine in St. Louis, said the study may not be generalizable to the U.S. because the Chinese herbal medicine used in the study is not available here, according to Medscape.  But Dr. Davis noted that the study brings to light a cause of anuric acute kidney failure.


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