Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine Article

Full Text via DOI: 10.1159/000487149 PMID: 29705806 Web of Science: 000433957700003

Cited authors

  • Velez, Juan Carlos Q.; Obadan, Ndidiamaka O.; Kaushal, Amit; Alzubaidi, Mohammed; Bhasin, Bhavna; Sachdev, Sachin H.; Karakala, Nithin; Arthur, John M.; Nesbit, Ross M.; Phadke, Gautam M.


  • Background: Vancomycin-associated (VA) acute kidney injury (AKI) is being increasingly recognized. A distinct pattern of rapid rise in serum creatinine (sCr) during VA-AKI has occasionally been observed. However, such scenarios remain underreported. Methods: We conducted an online survey at the American Society of Nephrology Communities forum and reviewed publications of VA-AKI via PubMed or Google searching for cases of precipitous AKI (those with rise in sCr >= 1.5 mg/dL/day) attributable to vancomycin. Results: We identified 12 original cases compiled from 6 different hospi-tals and 4 published cases (n = 16; 38% women, age 43.5 +/- 16 years, weight 108 +/- 23 kg, body mass index 35 +/- 7 kg/m(2)) of precipitous AKI observed shortly after large cumulative doses of VA (8.8 +/- 5 g). The median steepest 24-h rise in sCr was 2.6 mg/dL (range 1.5-3.5 mg/dL) and the slope of the initial 48-h sCr rise was greater than that of a control AKI (non-VA, n = 48) group (2.03 +/- 0.1 vs. 0.62 +/- 0.0 mg/dL/day; p < 0.0001). The steep rise in sCr in the VA-AKI was not accompanied by anuria. Overt rhabdomyolysis was absent in all cases. Further, in 3 precipitous VA-AKI cases, simultaneous serum cystatin C values did not rise precipitously, suggesting that the reductions in glomerular filtration rate were overestimated by the sCr increase. Conclusions: VA-AKI can manifest with a precipitous rise in sCr shortly after a high cumulative dose of vancomycin. True toxic tubular injury overrepresented by the sCr rise is postulated. (C) 2018 S. Karger AG, Basel

Publication date

  • 2018

Published in


International Standard Serial Number (ISSN)

  • 1660-8151

Start page

  • 131

End page

  • 142


  • 139


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