Acyclovir-induced renal failure: course and risk factors

Abstract

Of 19 children treated with high-dose intravenous acyclovir, 7, all of whom had encephalitis, also had a restricted fluid intake. Of these, 3 experienced non-oliguric renal insufficiency (plasma creatinine up to 176, 250 and 351 mumol/l, respectively) which resolved within 1 week of discontinuing acyclovir. Renal function was stable in the remaining 4 patients in this group and in the 12 children treated with acyclovir but without fluid restriction. We suggest the decreased renal function resulted from intratubular acyclovir crystalluria.

Acute renal failure in a child associated with acyclovir

“…Major risk factors for acyclovir nephrotoxicity include high blood concentrations caused by dosages greater than 500 mg/m 2 per 8 h, bolus intravenous administration, preexisting renal disease, dehydration and associated use of other nephrotoxic agents [1,3,5,7]. In our patient, ceftriaxone was administered and this drug has been reported to cause ureteral calculi in at least one child [9].…”

“…Renal failure due to acyclovir is usually non-oliguric, although serum creatinine values may be greatly elevated. Acyclovir-induced renal failure is also usually transient and most cases resolve spontaneously after discontinuation of acyclovir, with complete restoration of normal renal function [2,5,7]. If renal function does not begin to improve shortly after discontinuation of acyclovir, other causes of acute renal failure should be investigated.…”

“…Acyclovir levels in kidney tissue can reach 10 times those in serum and may account for the propensity of this drug to cause nephrotoxicity [8]. The urinary sediment examined by polarizing microscopy showed birefringent needleshaped crystals within leukocytes in patients with high urine concentrations of acyclovir [5,7]. Acyclovir crystals were shown to have precipitated in the renal collecting tubules and caused obstructive nephropathy leading to renal failure [7].…”

“…Renal dysfunction has been reported to consist of elevated blood urea nitrogen (BUN) and serum creatinine, abnormal urine sediment and overt acute and chronic renal failure [1][2][3][4][5]. Adverse effects have been reported in patients given both large and low doses of acyclovir by both rapid and slow intravenous infusion, as well as with oral acyclovir [1][2][3][4][5]. As acyclovir is more widely used, adverse reactions probably will be encountered more frequently.…”

“…Reports of adverse effects are uncommon and occur almost always in adults, with renal dysfunction and neurotoxicity being most frequently reported [1][2][3][4]. Renal dysfunction has been reported to consist of elevated blood urea nitrogen (BUN) and serum creatinine, abnormal urine sediment and overt acute and chronic renal failure [1][2][3][4][5]. Adverse effects have been reported in patients given both large and low doses of acyclovir by both rapid and slow intravenous infusion, as well as with oral acyclovir [1][2][3][4][5].…”