Vancomycin- and piperacillin-induced acute interstitial nephritis in a patient with lupus: A case report showcasing rapid decline in renal function.

Oluwadamilola Adisa, Anil Ananthaneni, Bryce Rushing, Nathan Rinehouse, Phani Morisetti
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Abstract

Drug-induced acute interstitial nephritis (AIN) presents as acute kidney injury (AKI) with the use of certain offending drugs. Antibiotics, such as β-lactams, trimethoprim-sulfamethoxazole, fluoroquinolones, and rifampin, account for up to 50% of drug-induced AIN cases. The onset of drug-induced AIN following drug exposure usually ranges from few days to several weeks or months. We present a patient with lupus who had rapid decline in renal function with a single dose of vancomycin and piperacillin-tazobactam (VPT) administration, termed as the "workhorse" regimen at many institutions. In addition, she did not exhibit many clinical and laboratory signs of AIN, making diagnosis challenging. Prompt kidney biopsy and early steroid therapy had a critical role in recovery of the patient's renal function. The median duration for renal impairment in vancomycin-induced AIN is 26 days. Onset of AKI is usually rapid from VPT, within 3 - 5 days of drug exposure. However, the severity of AKI is often low, in contrast to this patient whose AKI reached a stage 3 (AKIN/KDIGO) within 2 days from drug exposure. This study highlights the nephrotoxic potential of piperacillin, especially when used along with vancomycin, concurrent with recent evidence. Within rising antibiotic usage rates, is important to consider AIN in the differential diagnosis of rapidly declining AKI, especially with the combined use of VPT.

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万古霉素和哌拉西林诱导的狼疮患者急性间质性肾炎:一例报告显示肾功能迅速下降。
药物性急性间质性肾炎(AIN)表现为急性肾损伤(AKI),与某些致病药物的使用有关。抗生素,如β-内酰胺类、甲氧苄啶-磺胺甲恶唑、氟喹诺酮类和利福平,占药物性AIN病例的50%。药物暴露后药物性AIN的发作通常从几天到几周或几个月不等。我们报告了一例狼疮患者,其肾功能迅速下降,单剂量万古霉素和哌西林-他唑巴坦(VPT)给药,在许多机构被称为“工作马”方案。此外,她没有表现出AIN的许多临床和实验室体征,这使得诊断具有挑战性。及时肾活检和早期类固醇治疗对患者肾功能恢复起着至关重要的作用。万古霉素引起的AIN肾损害的中位持续时间为26天。静脉血栓栓塞通常在药物暴露后3 - 5天内迅速发生AKI。然而,AKI的严重程度通常较低,与此患者相比,其AKI在药物暴露后2天内达到3期(AKIN/KDIGO)。这项研究强调了哌拉西林的肾毒性潜力,特别是当与万古霉素一起使用时,与最近的证据一致。在抗生素使用率上升的情况下,在快速下降的AKI的鉴别诊断中考虑AIN是很重要的,特别是在联合使用VPT的情况下。
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