Colistin Nephrotoxicity: Report of a Case With Light and Electron Microscopic Studies1

Abstract

A case of colistln nephrotoxicity without history of previous renal disease was studied by light and electron microscopy of a renal biopsy specimen obtained 11 days after discontinuation of the drug. The histologic picture showed variation from early acute necrosis to regeneration of the damaged renal epithelium. There appeared to be difference of susceptibility among individual tubular epithelial cells to sodium colistinmethanesulfonate in the development of nephrotoxicity. Morphological changes were essentially similar in both the proximal and distal tubules. Indentation of the nuclear membranes was conspicuous and appeared to be demonstrable earlier than the cytoplasmic alterations. ACTA PATH. JAP. 19: 55˜67, 1969.

Systemic colistin use in children without cystic fibrosis: a systematic review of the literature

“…This fact raised suspicion regarding the safety profile of systemic colistin treatment, which was illustrated by the gradual withdrawal of parenteral colistin treatment from clinical practice during the late 1970s and early 1980s [76]. The significant number of older studies (21 of 25 included) [44][45][46][47]50,[52][53][54][56][57][58][59][60][61][62][63][64][65][66][67][68] generated from our literature search and also included in this review illustrates the common use of systemic colistin for the treatment of children with Gram-negative infections and also for prophylaxis until the late 1970s. The lack of published experience regarding the systemic use of colistin in the 1980s and early 1990s is the result of the fear of nephrotoxicity that led to the abandonment of colistin after the negative experience provided by the case reports referring to children and included in our study, as well as from studies referring to adult populations [77][78][79].…”

“…Three of the 15 included children were cured from the infection [51,55,64] and1 improved [50]. Six deaths were reported; two were attributed to the index infection [54,56], one due to secondary haematogenous infection [66], two due to cardiac arrest [48,53] and the remaining one due to acute renal failure attributed to colistin overdosage [61].…”

“…In 7 of 15 included children, an accidental overdosage of colistin occurred [44][45][46][47]60,61,64]. Other antimicrobial agents were administered concomitantly to colistin in 7 of the 15 included children [44][45][46]48,50,54,61]. Specific data are presented in Table 3.…”

“…Specifically, four children developed acute renal failure due to accidental colistin overdosage and simultaneously exhibited signs of neurotoxicity [45,46,61,64] (manifested mainly by symptoms such as muscular weakness, mild dysarthria or slowed speech, visual disturbance, mild ataxia and apnoea (1 case) [46]), two presented with oliguria (reversible in one child) [47,56], one manifested with anuria due to colistin overdosage (requiring peritoneal and exchange transfusion) [44], one with acute tubular necrosis (confirmed by renal biopsy) [50] and one with a rise in serum creatinine levels after receiving the appropriate colistin dose (this child had an impaired renal status prior to the institution of colistin) [66]. In 1 of the 15 children, occurrence of leukocytosis led to discontinuation of colistin treatment [55].…”

“…Among these, 25 articles (10 case series and 15 case reports) qualified for inclusion in this review . The 10 case series included in the review presented a total of 355 children [49,52,[57][58][59]62,63,65,67,68] and the 15 case reports presented 15 children [44][45][46][47][48]50,51,[53][54][55][56]60,61,64,66]. The detailed process of the selection of eligible trials is depicted graphically in Fig.…”