Kidney Week

Abstract: PUB013

Valacyclovir-Induced Crystal Kidney Failure: An Underestimated Adverse Effect of a Well-Known Drug

Session Information

• Publication Only

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Bell, Abraham, Florida State University, Tallahassee, Florida, United States

Abraham Bell, DO

• Milutinovic, Stefan, Florida State University, Tallahassee, Florida, United States

Stefan Milutinovic, MD

• Maddineni, Gautam, Florida State University, Tallahassee, Florida, United States

Gautam Maddineni, MD

• Bell, Isaac, Nova Southeastern University, Fort Lauderdale, Florida, United States

Isaac Bell, DO

• Oliveira, Meloney, Florida State University, Tallahassee, Florida, United States

Meloney Oliveira, MD

Introduction

Valacyclovir is an oral antiviral drug used to treat herpetic infections. Valacyclovir related acute kidney injury (AKI) is described as a rare side effect. The mechanism of nephrotoxicity includes crystal deposition in the renal tubules resulting in intratubular obstruction and local interstitial inflammation. The risk of AKI increases with other risk factors for AKI are present such as chronic kidney disease, hypovolemic, overdose of the medication or concomitant use of known nephrotoxic medications. We used the FDA Adverse Events Reporting System (FAERS) to quantify the reported incidence of valacyclovir induced AKI.

Case Description

A 60 yo lady with a past medical history of hypothyroidism and hypertension presented to the ER with new visual hallucinations. Her symptoms were associated with new onset nausea, vomiting and generalized weakness. Five days prior to her acute presentation, she had been prescribed a 7-day course of valacyclovir to treat an acute herpes zoster lesion. Labs revealed a serum creatinine of 7 mg/dL (2 weeks prior serum creatinine was 0.8 mg/dL), UA with brown granular casts. Urine eosinophils were negative. She received IV fluids in the emergency department that were continued on admission and her renal function started to improve.

Discussion

Data published in FAERS suggests that the rate of AKI with concomitant valacyclovir is greater than 7.49% in over 1,434 cases since 1995. It is the second most common side effect associated with the drug reported in FAERS. The rate of AKI with concomitant acyclovir is 8.63% in reported cases since 1995, which is not significantly more in comparison to valacyclovir.