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Researchers Link Ceftriaxone to Acute Renal Failure in Children

Filed April 2nd, 2014 Laurie

According to a study published online on March 24 in the journal Pediatrics, ceftriaxone used at therapeutic doses can cause kidney stones and pediatric acute renal failure (PARF). The study’s authors are advising doctors to immediately discontinue use of the drug in children who develop sudden-onset anuria or flank pain.

“Ceftriaxone therapy in children may cause PARF,” the authors note, “Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment for those who fail to respond to pharmacotherapy.”

Ceftriaxone, commonly used to treat infections in children, has been linked to biliary pseudolithiasis, nephrolithiasis, and bladder sludge, according to the article. The antibiotic has been known to cause the formation of urine crystals that cling to renal tubular cells has been observed during ceftriaxone treatment, which can lead to acute renal failure, reported.

For the study, researchers looked at 31 cases of children with PARF after treatment with ceftriaxone from January 1, 2003, to June 30, 2012, at Tongji Hospital, Wuhan, China, including youngsters with no previous history of urolithiasis or nephropathy, according to

“Ceftriaxone treatment was verified from 9 patient records and by parent report in 22 children. PARF diagnosis was based on symptomatology (sudden onset anuria, flank or renal percussion pain) and laboratory values (serum creatinine and/or urea nitrogen). Pharmacotherapy included spasmolysis with anisodamine, alkalization with sodium bicarbonate, antibiotics, albumen, and low-dose dexamethasone, wrote.

The children were given ceftriaxone, on average, for 5.2 days before PARF set in. Doses were available in 13 cases and ranged from 70 to 100 mg/kg per day (mean, 86.7 mg/kg per day). Predominant symptoms included sudden-onset anuria for at least 24 hours (31/31), flank pain (>3 years, 25/25), excessive crying (<3 years, 6/6), and/or vomiting (19/31). On ultrasound, there was mild hydronephrosis in 25 of 31 children and ureteric calculi in 11 of 31, according to Nine children recovered after 1 to 4 days of ceftriaxone treatment, but 21 children were resistant to the medication regimen and received retrograde ureteral catheterization, restoring normal urine flow in 20 of the children. One child suffered dense calculi that impeded catheterization, requiring 3 sessions of hemodialysis to restore urination. Calculi could be recovered from 4 children, and tandem mass spectrometric analysis revealed the main component to be ceftriaxone. Mean treatment duration was 1.8 days, with a mean anuria period of 3.1 days, reported. In addition to discontinuing the drug, the study’s authors also recommend that symptomatic children undergo further evaluation with blood tests and ultrasounds, with early treatment on confirmation of the diagnosis, according to Researchers said they are unaware of any solid preventative measures.

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