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Ciprofloxacin crystal nephropathy.

Piero Stratta1, Elisa Lazzarich, Caterina Canavese

  • 1Clinical and Experimental Medicine, Section of Nephrology, Amedeo Avogadro University, Maggiore Hospital, Novara, Italy. strattanefro@hotmail.com

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|July 31, 2007
PubMed
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Ciprofloxacin can cause kidney damage through crystal nephropathy, even at standard doses. This study highlights the risk of acute, reversible tubular damage from ciprofloxacin crystals in patients.

Area of Science:

  • Nephrology
  • Pharmacology
  • Toxicology

Background:

  • Ciprofloxacin, a common fluoroquinolone antibiotic, is generally considered safe for renal function.
  • Previous understanding suggested direct renal damage was rare and linked to overdose, with immune-mediated interstitial nephritis being the primary concern.
  • Experimental data indicated crystalluria risk, but human occurrence was deemed low due to pH dependency (>6.8).

Observation:

  • Two cases of ciprofloxacin crystal-induced nephropathy are presented.
  • Patients exhibited acute, reversible tubular damage.
  • Intratubular crystals consistent with ciprofloxacin were identified.

Findings:

  • Ciprofloxacin crystal nephropathy can occur within therapeutic dosage ranges.
  • The observed renal damage presented as acute tubular injury.

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  • Crystals found in renal tubules were negative for phosphate and calcium stains.

    • Implications:

    • This challenges the previous assumption of low risk for ciprofloxacin crystal nephropathy in humans.
    • Clinicians should consider crystal nephropathy in patients presenting with acute kidney injury on ciprofloxacin therapy.
    • Further research may be needed to elucidate the precise mechanisms and risk factors for ciprofloxacin-induced crystal nephropathy.