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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
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Reduction of Vancomycin-Associated Acute Kidney Injury With Montelukast
Nicholas S Teran1,2, Cole S Hudson3, Kady Phe2
1Department of Pharmacy Practice and Translational Research, College of Pharmacy, University of Houston.
The Journal of Infectious Diseases
|January 15, 2025
Summary
Montelukast may protect against vancomycin-induced acute kidney injury (AKI). This study found a lower AKI prevalence in patients receiving montelukast alongside vancomycin, suggesting a potential renal protective effect.
Area of Science:
- Nephrology
- Pharmacology
- Antimicrobial Therapy
Background:
- Vancomycin is crucial for treating resistant Gram-positive infections but is linked to nephrotoxicity.
- Pre-clinical models suggest montelukast may reduce vancomycin-associated acute kidney injury (AKI).
Purpose of the Study:
- To investigate if montelukast reduces the incidence of vancomycin-associated AKI in adult patients.
Main Methods:
- Retrospective cohort study of adult patients receiving intravenous vancomycin (Jan 2020-Jan 2024).
- AKI identified using RIFLE criteria.
- A pre-clinical model explored renal protective mechanisms.
Main Results:
- Patients receiving montelukast (n=110) had lower AKI rates (2.7%) compared to controls (n=330, 10.6%; P=0.01).
- Multivariate analysis indicated montelukast (OR: 0.26) and male gender were protective against AKI.
- Weight and ICU admission were independently associated with AKI.
- In vitro studies showed montelukast activates the p62/KEAP-1/HO-1 antioxidant pathway, protecting proximal tubule cells.
Conclusions:
- Montelukast may offer protection against vancomycin-associated AKI.
- This finding could reduce patient harm and healthcare costs.
- Prospective studies are needed to confirm these results.
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