Acute Interstitial Nephritis Associated With Vancomycin Therapy

Acute Interstitial Nephritis Associated with Coadministration of Vancomycin and Ceftriaxone: Case Series and Review of the Literature

“…The authors of this case report believed that ceftriaxone was most likely the cause of acute interstitial nephritis in this patient. The onset of vancomycin-induced and cephalosporin-induced acute interstitial nephritis, based on previously published case reports, ranges from 7-33 days [15][16][17][18] and 6 days-5 weeks 5-14 after administration of the offending agent, respectively, and is consistent with the onset of acute renal failure in both of our patients. The common clinical findings in our two patients were fever, eosinophilia, and rash (patient no.…”

“…Cephalosporin-induced acute interstitial nephritis has been described with cephaloridine, 4 cefaclor, 5 cephalothin, 4,6 cefazolin, 4 cephapirin, 4,7 cefotaxime, 8 cefoxitin, 9 cefotetan, 10 cefoperazone, 11 ceftriaxone, 12 cephradine, 13 and loracarbef. 14 A review of the literature identified four reports of vancomycin-induced acute interstitial nephritis [15][16][17][18] ; however, we did not find any reports of acute interstitial nephritis associated with concomitant vancomycin and ceftriaxone usage. We report two cases of reversible acute interstitial nephritis associated with coadministration of ceftriaxone and vancomycin.…”

“…In the published cases of vancomycin-induced acute interstitial nephritis, [15][16][17][18] the vancomycin dosage was adjusted to maintain peak serum concentrations less than 30 mg/L. It is possible that the elevated vancomycin trough level of 72.1 mg/L in our patient no.…”

“…2,3 Drug-induced immunologically mediated renal injury has also been associated with other agents including rifampin, 2 sulfonamides, 2 cephalosporins, 2, 5-14 and vancomycin. [15][16][17][18] Acute interstitial nephritis commonly occurs within 3-5 days after a second exposure to the offending drug(s) and may take several weeks with a first exposure. 2,19 The clinical manifestation of acute interstitial nephritis varies depending on the specific drug and patient response.…”

“…We were unable to obtain a copy of one of the reported cases, therefore a total of 10 case reports of cephalosporin-induced acute interstitial nephritis and 4 case reports of vancomycin-induced acute interstitial nephritis are summarized in Table 2. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] The only reported case of ceftriaxone-induced acute interstitial nephritis involved a 5-year-old girl who developed acute renal failure on the ninth day of ceftriaxone and ampicillinsulbactam therapy for pneumonia. 12 The patient underwent peritoneal dialysis and recovered without corticosteroid therapy.…”