Abstract: FR-PO057
AKI after Vancomycin Treatment: Need for Kidney Biopsy
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Satoskar, Anjali A., The Ohio State University, Columbus, Ohio, United States
- Biederman, Laura, The Ohio State University, Columbus, Ohio, United States
- Kitamura, Mineaki, Nagasaki Daigaku Daigakuin Ishiyakugaku Sogo Kenkyuka, Nagasaki, Nagasaki, Japan
Background
Vancomycin is the antibiotic of choice for methicillin-resistant Staphylococcus aureus infections, often given empirically, even before culture results become available. However it is known for its nephrotoxic effect. Acute tubular necrosis (ATN) and mild acute interstitial nephritis (AIN) are the morphologic correlates in the kidney. But a substantial number of kidney biopsies performed for AKI following Vancomycin treatment instead show infection-related glomerulonephritis (IRGN). It is difficult to predict one versus the other. Analysis was performed to see if significant differences in demographic features exist that might help.
Methods
We searched our Pathology files for kidney biopsies with the term "vancomycin" in the clinical history. We retrieved a total of 354 biopsies between 2004 and 2017. Three broad diagnostic categories emerged: Group I- ATN with or without AIN (n=200); Group II - infection-related glomerulonephritis (IRGN) (n=94); and Group III (n=60) - other glomerular or vascular disease (n=60). Statistical comparison was performed for patient age, sex and ethnicity between these groups.
Results
Groups II and III comprised 44% of this cohort. In Group II, 23/94 showed resolving IRGN with mild IgA deposits and 67/94 also showed active proliferative glomerular lesions. Group III contained cases of ANCA-associated GN, cryoglobulinemic GN, proliferative GN with monoclonal IgG deposits (PGNMID), a few lupus nephritis, fibrillary GN and thrombotic microangiopathy (TMA). No significant differences in age or sex were identified between the three groups. Average age was 55.7, 57.7 and 56.8 years respectively. African American ethnicity was more represented in Group III (Pearson Chi-square test p = 0.0005).
Conclusion
AKI in patients receiving Vancomycin may not always be due to drug-induced ATN/AIN alone. Other concomitant pathologies may be present. IRGN can develop despite ongoing antibiotic treatment, in some but not all patients with infection, but is difficult to predict. Although, IRGN is reported to show predilection for older age, male sex and Caucasian background, these demograpic features did not help predict IRGN vesus Vancomycin-induced ATN in this cohort. Urinalysis may offer clues in non-oliguric patients. But kidney biopsy assumes importance. Further studies with urinalysis findings, Vancomycin trough levels, nature of infection are needed.