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Assessment of Causality in Hospitalized Children With Aminoglycoside-Related Nephrotoxicity

Madhileti Sravani1, Sriram Krishnamurthy2, Narayanan Parameswaran1

  • 1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.

Indian Pediatrics
|January 7, 2022
PubMed

Insights

Aminoglycoside antibiotics can cause kidney injury in children. This study found that while many children experienced acute kidney injury (AKI), only a small percentage had it definitively linked to the drug, suggesting other factors may be involved.

Area of Science:

  • Pediatric Nephrology
  • Pharmacovigilance
  • Adverse Drug Reactions

Background:

  • Aminoglycosides are crucial antibiotics for treating severe pediatric infections.
  • Nephrotoxicity is a known, but often poorly quantified, adverse effect of aminoglycoside therapy in children.

Purpose of the Study:

  • To determine the incidence of aminoglycoside-induced nephrotoxicity in pediatric patients.
  • To establish drug causality for observed kidney injury.
  • To identify risk factors associated with aminoglycoside-related nephrotoxicity.

Main Methods:

  • Prospective study of 110 children (1 month-12 years) receiving aminoglycosides for ≥4 days.
  • Utilized the Liverpool adverse drug reaction causality assessment tool to evaluate drug causality.
  • Monitored for acute kidney injury (AKI) and tubular dysfunction.

Main Results:

  • 38.2% of children developed AKI; 64.5% had composite nephrotoxicity.
  • Only 15.5% of AKI cases were definitively attributed to aminoglycosides.
  • Hypotension, high PRISM-III scores (20-29%), and post-surgery status were independent predictors of AKI.

Conclusions:

  • A small proportion of pediatric AKI cases in patients receiving aminoglycosides are definitively attributable to the drug.
  • Risk factors like hypotension and critical illness scores are associated with AKI in this population.
  • Further research is needed to elucidate the precise mechanisms and contributing factors to aminoglycoside nephrotoxicity.
Abstract

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