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Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application
Wei-Chih Kan1,2, Yi-Chih Chen3, Vin-Cent Wu4
1Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan.
Abstract:
Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critically ill patients. The current review comprehensively summarizes the pathophysiological mechanisms of, biomarkers for, preventive strategies for, and some crucial issues with VA-AKI. The pathological manifestations of VA-AKI include acute tubular necrosis, acute tubulointerstitial nephritis (ATIN), and intratubular crystal obstruction. The proposed pathological mechanisms of VA-AKI include oxidative stress and allergic reactions induced by vancomycin and vancomycin-associated tubular casts. Concomitant administration with other nephrotoxic antibiotics, such as piperacillin-tazobactam, high vancomycin doses, and intermittent infusion strategies compared to the continuous infusion are associated with a higher risk of VA-AKI. Several biomarkers could be applied to predict and diagnose VA-AKI. To date, no promising therapy is available. Oral steroids could be considered for patients with ATIN, whereas hemodialysis might be applied to remove vancomycin from the patient. In the future, disclosing more promising biomarkers that could precisely identify populations susceptible to VA-AKI and detect VA-AKI occurrence early on, and developing pharmacological agents that could prevent or treat VA-AKI, are the keys to improve the prognoses of patients with severe infection who probably need vancomycin therapy.
Insights
Vancomycin-associated acute kidney injury (VA-AKI) is a significant concern in critically ill patients. Understanding its mechanisms and identifying predictive biomarkers are crucial for prevention and treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Vancomycin is a critical antibiotic for hospitalized patients, but it can cause acute kidney injury (AKI).
- Vancomycin-associated AKI (VA-AKI) is a complex condition in critically ill patients requiring further understanding.
- This review synthesizes current knowledge on VA-AKI's mechanisms, diagnosis, and management.
Purpose of the Study:
- To comprehensively review the pathophysiological mechanisms of vancomycin-associated AKI.
- To summarize biomarkers for predicting and diagnosing VA-AKI.
- To discuss preventive strategies and current therapeutic options for VA-AKI.
Main Methods:
- Literature review of pathophysiological mechanisms, biomarkers, and clinical issues related to VA-AKI.
- Analysis of pathological manifestations including acute tubular necrosis, interstitial nephritis, and crystal obstruction.
- Identification of risk factors such as co-administration with nephrotoxic drugs and infusion strategies.
Main Results:
- Pathological mechanisms involve oxidative stress, allergic reactions, and vancomycin-induced tubular casts.
- Risk factors include concurrent use of piperacillin-tazobactam, high vancomycin doses, and intermittent infusion.
- Several biomarkers show potential for VA-AKI prediction and diagnosis, though no definitive therapy exists.
Conclusions:
- VA-AKI presents with diverse pathological findings and multifactorial mechanisms.
- Early identification of susceptible patients and development of targeted therapies are essential for improving outcomes.
- Further research into novel biomarkers and pharmacological agents is critical for managing VA-AKI.
