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[Obstructive renal insufficiency caused by amoxicillin crystalluria]
M Boursas1, L Benhassine, J Kempf
1Fédération d'anesthésie-réanimation-Smur, centre hospitalier, Haguenau, France.
Abstract:
A 76-year-old woman was admitted to the ICU for a meningitis with rhombencephalitis due to Listeria monocytogenes. The treatment included amoxicillin (250 mg.kg-1.day-1) and gentamicin (3 mg.kg-1.day-1 over 6 days). Neurological outcome was favourable. However at the 14th day, an acute renal failure occurred, following macroscopic haematuria and milkiness urine. CT scan and sonography confirmed the diagnosis of obstructive renal failure with bilateral ureteral obstruction. Crystalluria caused by amoxicillin was suspected. Endoscopic ureteral insertion of double-J catheters permitted the recovery of a normal renal function.
Insights
Listeria meningitis treatment with amoxicillin and gentamicin led to acute kidney injury due to amoxicillin-induced crystalluria. Prompt intervention with double-J catheters successfully restored renal function.
Area of Science:
- Infectious Diseases
- Nephrology
- Pharmacology
Background:
- Listeria monocytogenes can cause severe infections like meningitis and rhombencephalitis.
- Treatment regimens for Listeria infections often involve antibiotics such as amoxicillin and gentamicin.
- Acute kidney injury (AKI) is a potential complication of certain antibiotic therapies.
Observation:
- A 76-year-old female patient developed meningitis with rhombencephalitis due to Listeria monocytogenes.
- The patient received amoxicillin and gentamicin for treatment.
- Post-treatment, the patient presented with macroscopic hematuria, milky urine, and acute renal failure.
Findings:
- Diagnostic imaging (CT scan, sonography) revealed obstructive renal failure with bilateral ureteral obstruction.
- Amoxicillin crystalluria was identified as the suspected cause of the obstruction.
- The patient's renal function normalized after endoscopic ureteral insertion of double-J catheters.
Implications:
- This case highlights a rare but serious adverse effect of amoxicillin therapy.
- Early recognition of crystalluria is crucial for managing antibiotic-induced nephrotoxicity.
- Urgent urological intervention can effectively manage obstructive nephropathy and preserve renal function.