Ceftriaxone induced hemolysis complicated by acute renal failure

Kapur, Gaurav; Valentini, Rudolph P.; Mattoo, Tej K.; Warrier, Indira; Imam, Abubakr

doi:10.1002/pbc.20839

Cited by 30 publications

(21 citation statements)

References 22 publications

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“…Some children have dramatic HA; 50% are reported as fatal HA. 4,31 Analysis of 21 patients (15 children and 6 adults) we studied showed that 40% of the children started hemolyzing ≤ 1 hr after receiving ceftriaxone. Hemoglobin levels fell to ≤ 5g/dL in 62% and to ≤ 1 g/dL in 20% of the patients.…”

Section: Cephalosporinsmentioning

confidence: 99%

Drug-induced immune hemolytic anemia

Garratty¹

2009

Hematology

205

229

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Drug-induced immune hemolytic anemia (DIIHA) is rare, and a specialized laboratory is often required to provide the optimal serological tests to confirm the diagnosis. The most common drugs associated with DIIHA and the hypotheses for the mechanisms thought to be involved have changed during the last few decades. The drugs most frequently associated with DIIHA at this time are cefotetan, ceftriaxone, and piperacillin. DIIHA is attributed most commonly to drug-dependent antibodies that can only be detected in the presence of drug (eg, cephalosporin antibodies). DIIHA can also be associated with drug-independent antibodies; such antibodies do not need drug to be present to obtain in vitro reactions (eg, fludarabine). In these latter cases, the drug affects the immune system, causing production of red cell (RBC) autoantibodies; the clinical and laboratory findings are identical to autoimmune hemolytic anemia (AIHA), other than the remission associated with discontinuing the drug. Some of the mechanisms involved in DIIHA are controversial. The most acceptable one involves drugs, like penicillin, that covalently bind to proteins (eg, RBC membrane proteins); RBCs become coated with drug in vivo and, a drug antibody (usually IgG) attaches to the drug-coated RBCs that are subsequently cleared by macrophages. The most controversial is the so-called immune complex mechanism, which has been revised to suggest that most drugs are capable of binding to RBC membrane proteins, but not covalently like penicillins. The combined membrane plus drug can create an immunogen; the antibodies formed can be IgM or IgG and often activate complement, leading to acute intravascular lysis and sometimes renal failure; fatalities are more common in this group. It is still unknown why and how some drugs induce RBC autoantibodies, sometimes causing AIHA.

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Section: Cephalosporinsmentioning

confidence: 99%

Drug-induced immune hemolytic anemia

Garratty¹

2009

Hematology

205

229

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“…4,6,7,[16][17][18][19][20][21][22][23]25,[28][29][30][31] There was no information reported in the remaining 5 patients. 3,5,24,26,27 It is unclear whether the underlying disease processes contribute to the development of anticeftriaxone antibodies and hemolysis, or if repeated exposure to the drug is important, or both. 13 Hemolysis in pediatric patients with CIHA usually occurs within 30 minutes (range, 5 to 120 min) of ceftriaxone administration.…”

Section: Discussionmentioning

confidence: 99%

Ceftriaxone-induced Hemolytic Anemia

Northrop

Agarwal

2015

Journal of Pediatric Hematology/Oncology

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Ceftriaxone is a frequently used empiric antibiotic in children. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with a high mortality rate. A 14-year-old boy suffering from Crohn disease developed bacterial pneumonia that was treated with ceftriaxone. We report successful management of ceftriaxone-induced hemolytic anemia (CIHA) in this patient and review the CIHA literature in pediatric patients. Early recognition of CIHA with prompt discontinuation of ceftriaxone therapy may have a beneficial role in reduction of high mortality seen in these patients.

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“…[4][5][6][7] However, ceftriaxoneassociated PARF [9][10][11] has been rarely reported. In this study we identified 31 children who had PARF who had a definite history of ceftriaxone treatment demonstrating the causal role of ceftriaxone in PARF.…”

Section: Discussionmentioning

confidence: 99%

“…To date there are only a few studies reporting on PARF associated with ceftriaxone. [9][10][11] Our aim was to study the clinical features, treatment, and outcome of ceftriaxone-associated PARF in children. …”

mentioning

confidence: 99%

Ceftriaxone and Acute Renal Failure in Children

Zhou

Yuan

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Ceftriaxone at therapeutic doses can lead to renal stone formation. WHAT THIS STUDY ADDS:Renal stone formation with ceftriaxone therapy can result in postrenal acute renal failure in children. The condition can be treated effectively by timely pharmacotherapy or retrograde ureteral catheterization with good prognosis. abstract OBJECTIVE: Our aim was to evaluate the clinical profile, treatment, and outcome of ceftriaxone-associated postrenal acute renal failure (PARF) in children. METHODS:We retrospectively studied 31 consecutive cases from 2003 to 2012 for PARF after ceftriaxone treatment. There was no past history of urolithiasis or nephropathy in these children. RESULTS:The average time of ceftriaxone administration before PARF was 5.2 days. The major symptoms apart from anuria included flank pain (.3 years old, 25/25), excessive crying (,3 years, 6/6), and vomiting (19/33). Ultrasound showed mild hydronephrosis (25/31) and ureteric calculi (11/31). Nine children recovered after 1 to 4 days of pharmacotherapy. Twenty-one children who were resistant to pharmacotherapy underwent retrograde ureteral catheterization. After catheterization of their ureters, normal urine flow was observed, and the symptoms subsided immediately. Catheter insertion failed in 1 child who subsequently underwent 3 sessions of hemodialysis before normal urination was restored. Ceftriaxone was verified to be the main component of the calculi in 4 children by tandem mass spectrometric analysis. The recovery was complete in all cases.CONCLUSIONS: Ceftriaxone therapy in children may cause PARF. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy. Pediatrics 2014;133:e917-e922 Ceftriaxone at therapeutic doses can lead to crystallization in the urine and these crystals adhere to the surface of renal tubular cells. 5 Severe nephrolithiasis can cause postrenal acute renal failure (PARF). To date there are only a few studies reporting on PARF associated with ceftriaxone. [9][10][11] Our aim was to study the clinical features, treatment, and outcome of ceftriaxone-associated PARF in children. METHODSBetween January 1, 2003 and June 30, 2012, of the 127 PARF children admitted to the Pediatric Surgery Department of Tongji Hospital, there were 31 children who had a history of ceftriaxone administration a few days before PARF. These children were identified as subjects for the study. The history of ceftriaxone treatment was verified from patient records in 9 children and reported by parents in the remaining 22 children.The diagnosis of PARF was based on sudden onset of anuria, flank pain, and renal percussion pain associated with elevated serum creatinine and/or serum urea nitrogen in a child who had no past history of urolithiasis. The renal ultrasonography findings included normal-sized kidneys, the presence or absence of hydronephrosis, or ureteric calculi with no renal v...

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Ceftriaxone induced hemolysis complicated by acute renal failure

Cited by 30 publications

References 22 publications

Drug-induced immune hemolytic anemia

Drug-induced immune hemolytic anemia

Ceftriaxone-induced Hemolytic Anemia

Ceftriaxone and Acute Renal Failure in Children

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