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[Acute renal failure after amoxicillin crystallization]
J J Boffa1, H De Preneuf, L Bouadma
1Service de Réanimation polyvalente, Hôpital Intercommunal André Grégoire, Montreuil.
Background:
Drug-induced nephrolithiasis is a rare finding, especially with beta-lactamins. We report a case of acute renal failure due to amoxicillin crystallization.
Case Report:
A 48 year-old woman was admitted because of pneumococcal meningitis. After 4 days on high-dose amoxicillin (320 mg/kg/day), she developed acute oliguric renal failure and amoxicillin crystallization was documented by infrared spectrometry. The outcome was favorable after amoxicillin dosage tapering, together with one single hemodialysis session and further hydratation.
Discussion:
Amoxicillin is mainly excreted in the urine in its unchanged form. The risk of crystalluria is increased by low urinary pH, low urine output and high-dose of the drug. Such a crystalluria should be accurately identified by infrared spectrometry.
Insights
High-dose amoxicillin can cause kidney problems, leading to acute renal failure due to drug crystallization. Reducing the dose and supportive care improved patient outcomes in this case.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Drug-induced nephrolithiasis is an uncommon adverse effect, particularly with beta-lactam antibiotics.
- Amoxicillin, a widely used antibiotic, can rarely lead to kidney complications.
Observation:
- A case report details a 48-year-old woman who developed acute oliguric renal failure after four days of high-dose amoxicillin therapy for pneumococcal meningitis.
- Crystallization of amoxicillin in the renal tubules was confirmed via infrared spectrometry.
Findings:
- High-dose amoxicillin administration (320 mg/kg/day) was associated with acute renal failure.
- Amoxicillin crystallization in the urine was identified as the cause of renal impairment.
- Favorable renal recovery was achieved through amoxicillin dosage reduction, hydration, and hemodialysis.
Implications:
- This case highlights the potential for amoxicillin to cause nephrolithiasis and acute kidney injury.
- Factors such as high dosage, low urinary pH, and reduced urine output may increase the risk of amoxicillin crystalluria.
- Accurate identification of amoxicillin crystalluria using infrared spectrometry is crucial for timely management.