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[Reversible ceftriaxone-associated biliary pseudolithiasis in three children with renal diseases]
Xu-hui Zhong1, Huan Chen, Yong Yao
1Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Insights
Ceftriaxone treatment in children with renal diseases can lead to biliary pseudolithiasis. This condition, characterized by gallbladder sludge or stones, may be more common in pediatric patients with kidney issues receiving ceftriaxone.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Pharmacology
Background:
- Ceftriaxone is a commonly used antibiotic, but its association with biliary pseudolithiasis is a recognized adverse effect.
- Renal diseases can alter drug metabolism and excretion, potentially influencing the risk of antibiotic-associated complications.
Observation:
- This study retrospectively analyzed three pediatric cases with renal diseases who developed biliary pseudolithiasis during ceftriaxone therapy for gastroenteritis.
- Clinical manifestations included nausea, abdominal pain, and gallbladder sludge or stones detected via ultrasonography.
- Symptoms and sonographic abnormalities resolved after ceasing ceftriaxone treatment.
Findings:
- Biliary pseudolithiasis occurred in children with renal diseases even at low doses of ceftriaxone.
- The development of gallbladder sludge or stones appears to be reversible upon discontinuation of the antibiotic.
Implications:
- Patients with renal diseases, particularly children, may have an increased risk of ceftriaxone-associated biliary pseudolithiasis.
- Clinicians should consider this potential adverse effect when prescribing ceftriaxone to pediatric patients with kidney conditions.
Objective:
To study the clinical characteristics of ceftriaxone-associated biliary pseudolithiasis in children with renal diseases.
Method:
Three children with renal diseases developed biliary pseudolithiasis when they were treated with ceftriaxone. Their clinical and laboratory data were retrospectively analyzed.
Results:
Case one was an 11-year-old boy. The initial diagnosis was primary nephrotic syndrome. Ceftriaxone was administered intravenously at a dose of 2 g/d [50 mg/(kg * d)] for gastroenteritis. After that the boy complained of nausea and loss of appetite. Abdominal sonogram obtained on day 3 of ceftriaxone therapy revealed gallbladder sludge. After cessation of ceftriaxone treatment, symptoms and ultrasound abnormalities gradually disappeared, with complete sonographic resolution after 16 days. Case two was a 10-year-old boy. The primary diagnosis was post-streptococcal glomerulonephritis with acute renal failure. The child was treated with 1.5 g/d [30 mg/(kg * d)] intravenous ceftriaxone for gastroenteritis. After that, the boy complained of nausea and abdominal pain with positive Murphy's sign. Gallstone was detected by ultrasonographic examination on day 6 of ceftriaxone therapy. After cessation of ceftriaxone treatment, symptoms and sonographic abnormalities gradually disappeared, with complete sonographic resolution after 18 days. Case three was a 12-year-old boy. The primary diagnosis was nephrotic syndrome. He was treated with 2 g/d [40 mg/(kg.d)] ceftriaxone for gastroenteritis. Gallbladder lithiasis was detected 17 days after the initiation of ceftriaxone therapy (3 days after cessation of ceftriaxone treatment). Gallbladder sonogram was found to be normal two months after the discontinuation of the therapy.
Conclusions:
Biliary pseudolithiasis occurred in 3 cases with renal diseases receiving low doses of ceftriaxone. The risk of developing ceftriaxone-associated biliary pseudolithiasis might increase in patients with renal diseases who are treated with ceftriaxone.
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