Amoxicillin

Abstract

Acute kidney injury manifested as crystal nephropathy: 10 case reports In a monocentric retrospective cohort study, involving patients admitted to a hospital in France between September 2014 and October 2015, ten patients (seven women and three men) aged 47–86 years were described; they developed acute kidney injury manifested as crystal nephropathy during treatment with amoxicillin for hip arthroplasty infection, spondylodiscitis, septic arthritis or osteoarthritis. The patients had baseline creatinine level in the range of 0.51–1.2 mg/dL. Baseline estimated glomerular filtration rate was found to be 52–138 ml/min/1.73m2. The patients were admitted due to hip arthroplasty infection (seven patients) or spondylodiscitis, septic arthritis or osteoarthritis (one patient each). All patients had been receiving IV infusion of amoxicillin 9–15 g/day (133–211 mg/kg/day). Three to 27 days after the initiation of amoxicillin, the patients acute kidney injury manifested as crystal nephropathy. Kidney Disease: Improving Global Outcomes stage was 2 (two patients) or 3 (seven patients). Urine analysis revealed haematuria (nine patients), leucocyturia (six patients), crystalluria (one patient) and proteinuria (four patients, 0.02–0.63 g/mmoL). Urine pH was noted to be 5.5–7 (six patients). Seven out of the ten patients had urinary burns, back and hypogastric pain. Three out of the ten patients had urinary tract obstruction. Amoxicillin treatment was discontinued. The patients were treated with volume expansion therapy, unspecified crystalloids, sodium bicarbonate or Ringer’s lactate. Two out of the ten patients needed catheterisation. One out the ten patients received renal replacement therapy. Before discharge, the serum creatinine level returned to the baseline level in eight out of the 10 patients. Upon discharge, seven out of the 10 patients had serum creatinine level in the range of 0.53–3.4 mg/dL. During the three to 602 days follow-up, the last serum creatinine level was noted to be 0.48–1.1 mg/dL and the last estimated glomerular filtration rate was noted to be 51–136 ml/min/1.73m2 (all patients). Zero to 19 days after the discontinuation of amoxicillin, amoxicillin was reintroduced at a lower dose in four out of the ten patients [outcomes of the re-challenge not stated].