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Biopsy proven interstitial nephritis following treatment with vancomycin: a case report

Maria Nieva Salazar1, Marina Matthews, Aurora Posadas

  • 1Department of Internal Medicine, University of Connecticut Health Center, Farmington, USA.

Connecticut Medicine
|April 16, 2010
PubMed

Insights

Vancomycin can cause acute interstitial nephritis, a rare but serious kidney condition. Prompt diagnosis and steroid treatment are crucial for recovery, even after weeks of vancomycin use.

Area of Science:

  • Nephrology
  • Pharmacology
  • Infectious Diseases

Background:

  • Acute interstitial nephritis (AIN) is an uncommon adverse reaction to vancomycin.
  • Previous literature documented only six biopsy-proven cases of vancomycin-induced AIN.
  • This highlights the need for increased awareness of this potential complication.

Observation:

  • A 51-year-old male developed rash and acute kidney injury during vancomycin and gentamicin treatment for methicillin-resistant Staphylococcus aureus bacteremia.
  • Despite vancomycin discontinuation, renal function declined, necessitating prednisone initiation.
  • The patient experienced rapid renal function improvement after steroid therapy.

Findings:

  • Recurrence of acute kidney injury was observed upon non-compliance with steroid therapy.
  • Reinitiation of steroids led to another improvement in kidney function.
  • This case underscores the link between vancomycin and AIN, and the efficacy of steroids.

Implications:

  • Clinicians should suspect AIN in patients on vancomycin, irrespective of treatment duration.
  • Early recognition and intervention with steroids may be beneficial for vancomycin-induced AIN.
  • Further research into steroid efficacy for vancomycin-induced AIN is warranted, despite a lack of controlled trials.

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