Acyclovir-induced renal failure: course and risk factors

Area of Science:

• Pediatric Nephrology
• Virology
• Pharmacology

Background:

• Acyclovir is a widely used antiviral medication.
• High-dose intravenous administration is common for severe infections.
• Potential adverse effects, including renal toxicity, require careful monitoring.

Purpose of the Study:

• To investigate the incidence and characteristics of renal impairment in children receiving high-dose intravenous acyclovir.
• To identify risk factors associated with acyclovir-induced nephrotoxicity in pediatric patients.
• To explore the relationship between fluid intake and renal function during acyclovir therapy.

Main Methods:

• Retrospective analysis of 19 children treated with high-dose intravenous acyclovir.
• Categorization of patients based on fluid intake (restricted vs. non-restricted).
• Monitoring of renal function, including plasma creatinine levels.

Main Results:

• Seven of 19 children, all with encephalitis and restricted fluid intake, developed non-oliguric renal insufficiency.
• Renal impairment, characterized by elevated creatinine, resolved within one week of acyclovir discontinuation in affected patients.
• Renal function remained stable in patients without fluid restriction and in those with unrestricted fluid intake.

Conclusions:

• Restricted fluid intake in children receiving high-dose intravenous acyclovir, particularly those with encephalitis, is associated with an increased risk of renal insufficiency.
• Intratubular acyclovir crystalluria is the likely mechanism underlying the observed decrease in renal function.
• Maintaining adequate hydration is crucial for preventing acyclovir-induced nephrotoxicity in pediatric patients.