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Vancomycin-induced acute interstitial nephritis

A O Wai¹, A M Lo, A Abdo

¹Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.

The Annals of Pharmacotherapy

|November 24, 1998

Summary

Vancomycin can cause acute interstitial nephritis (AIN), an allergic kidney reaction. This adverse effect is important for clinicians to recognize, especially with increasing vancomycin use for resistant infections.

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Area of Science:

Nephrology
Pharmacology
Infectious Diseases

Background:

Vancomycin is frequently used for serious Gram-positive bacterial infections.
Acute interstitial nephritis (AIN) is a potential adverse drug reaction.
Literature on vancomycin-induced AIN is limited.

Observation:

A 64-year-old male developed fever, rash, acute renal failure, eosinophilia, and eosinophiluria after one month of vancomycin.
Renal biopsy confirmed an allergic drug reaction consistent with AIN.
Upon rechallenge with vancomycin, the patient exhibited rising eosinophils and eosinophiluria, but stable renal function.

Findings:

Vancomycin administration was linked to acute interstitial nephritis (AIN).
The patient's presentation and biopsy results were indicative of an allergic drug reaction.

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Rechallenge confirmed a hypersensitivity response to vancomycin.

Implications:

Clinicians must consider vancomycin as a potential cause of AIN.
Increased vigilance is necessary given the rising use of vancomycin for resistant infections.
Early recognition and discontinuation of vancomycin may prevent severe renal outcomes.