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Incidence and risk factors influencing the development of vancomycin nephrotoxicity in children
Susan McKamy1, Elvin Hernandez, Maximillian Jahng
1Miller Children's Hospital, 2801 Atlantic Avenue, PO Box 1428, Long Beach, CA 90801, USA. smckamy@memorialcare.org
Insights
Vancomycin-associated nephrotoxicity occurred in 14% of pediatric patients. High vancomycin troughs (≥ 15 mg/L) and furosemide use in the ICU significantly increased this risk.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Vancomycin is a critical antibiotic for treating serious Gram-positive infections.
- Nephrotoxicity is a known adverse effect of vancomycin, particularly in pediatric populations.
- Optimizing vancomycin dosing is crucial to balance efficacy and safety.
Purpose of the Study:
- To determine the incidence of vancomycin-associated nephrotoxicity in children.
- To identify risk factors for nephrotoxicity, focusing on serum trough concentrations.
- To evaluate the association between high vancomycin troughs (≥ 15 mg/L) and renal adverse events.
Main Methods:
- Retrospective evaluation of pediatric patients (≥ 1 week to ≤ 19 years) receiving vancomycin for ≥ 48 hours.
- Normal baseline serum creatinine values were required.
- Nephrotoxicity defined as a serum creatinine increase of ≥ 0.5 mg/dL or ≥ 50% from baseline over 2 days.
- Comparison of patients with average serum trough concentrations ≥ 15 mg/L versus those with lower troughs.
Main Results:
- Nephrotoxicity was observed in 14% of 167 pediatric patients.
- Patients with high average vancomycin troughs (≥ 15 mg/L) had a significantly higher incidence of nephrotoxicity (28% vs. 7.3%, P = .0001).
- Multivariable analysis identified high troughs (OR, 3.27) and concurrent furosemide use in the ICU (OR, 9.45) as independent risk factors for nephrotoxicity.
Conclusions:
- Close monitoring of renal function and vancomycin serum troughs is essential in pediatric patients.
- Particular attention should be paid to children receiving vancomycin with targeted troughs of ≥ 15 mg/L, especially those in intensive care settings or concurrently receiving furosemide.
Objective:
To determine the incidence of vancomycin-associated nephrotoxicity in children and to examine potential risk factors for nephrotoxicity, including average serum trough concentrations ≥ 15 mg/L.
Study Design:
Patients ≥ 1 week old to ≤ 19 years with normal baseline serum creatinine values who received vancomycin for ≥ 48 hours between December 2007 and April 2009 were retrospectively evaluated. Nephrotoxicity was defined as a serum creatinine increase of ≥ 0.5 mg/dL or ≥ 50% baseline increase over 2 days. Patients with average serum trough concentrations ≥ 15 mg/L were compared with a lower trough group.
Results:
Nephrotoxicity occurred in 14% of 167 patients. More patients who attained high average (≥ 15 mg/L) rather than low average (<15 mg/L) vancomycin troughs had nephrotoxicity (28% versus 7.3%, P = .0001). Using multivariable regression analysis, patients with high troughs and those receiving furosemide in the intensive care unit were more likely to have nephrotoxicity (OR, 3.27 [95% CI, 1.19 to 8.95], P = .021, and odds ratio, 9.45 [95% confidence interval, 3.44 to 26.00], P < .0001, respectively).
Conclusions:
Renal function and serum troughs in children receiving vancomycin, especially those with targeted troughs of ≥ 15 mg/L, in intensive care, and receiving furosemide, should be closely monitored.
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