Suspected acute interstitial nephritis induced by colistin

Area of Science:

• Nephrology
• Pulmonology
• Infectious Diseases

Background:

• Chronic obstructive pulmonary disease (COPD) exacerbations often require intensive care unit (ICU) admission and mechanical ventilation.
• Ventilator-associated pneumonia (VAP) is a serious complication in critically ill patients.
• Multidrug-resistant (MDR) pathogens necessitate the use of potent antibiotics like colistin.

Observation:

• A 35-year-old male with severe COPD experienced recurrent VAP caused by multidrug-resistant Pseudomonas aeruginosa.
• Initial treatment with imipenem and colistin for VAP showed no renal toxicity.
• Subsequent COPD exacerbations and VAP episodes treated with the same antibiotics led to rapid renal function decline, resolving upon colistin discontinuation.

Findings:

• The patient developed acute kidney injury (AKI) during the second and third VAP episodes, strongly correlated with colistin re-initiation.
• The Naranjo scale indicated a probable adverse drug reaction between colistin and renal failure.
• Histopathological findings and temporal association suggested colistin-induced acute interstitial nephritis, possibly allergic in nature.

Implications:

• Colistin, while effective against MDR pathogens, carries a risk of nephrotoxicity, particularly in patients with underlying renal compromise or during repeated exposures.
• Careful renal function monitoring is crucial during colistin therapy, especially in vulnerable patient populations.
• Alternative antibiotic strategies or dose adjustments may be necessary to mitigate nephrotoxic effects of colistin in patients with recurrent VAP and COPD.