ro13-9904 and Kidney-Calculi

Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published. In general, these adverse effects will develop after seven to ten days of treatment. We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment. Patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate.

Topics: Bile Duct Diseases; Ceftriaxone; Cephalosporins; Child; Diagnosis, Differential; Humans; Kidney Calculi; Lithiasis; Male; Meningitis, Bacterial; Neisseria meningitidis

Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications.. We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure.. Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure.. La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido, que se presenta en un 15 a 57% de los casos. En cambio la litiasis renal es extremadamente infrecuente con muy pocas publicaciones al respecto.. Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidronefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis.. La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Appendicitis; Ceftriaxone; Child; Humans; Kidney Calculi; Male; Pancreatitis

A 78-year-old man had been undergoing treatment with Cefamezin for pyogenic spondylitis. Because of complication of a urinary tract infection, the medication was switched to ceftriaxone (CTRX) 2 g/day. On day 18 after starting CTRX, the patient began experiencing abdominal pain. Computed tomography (CT) and endoscopic ultrasound led to the identification of calculi in the gallbladder and extrahepatic bile duct with a peculiar formation. We suspected CTRX-associated pseudo-cholecystolithiasis and pseudo-choledocholithiasis, although CT performed at admission had shown no such findings. Therefore, CTRX was discontinued. By day 17 after CTRX cessation, both the pseudo-cholecystolithiasis and pseudo-choledocholithiasis had disappeared.

Topics: Aged; Anti-Bacterial Agents; Bile Ducts, Extrahepatic; Cefazolin; Ceftriaxone; Cholecystolithiasis; Choledocholithiasis; Gallbladder Diseases; Humans; Kidney Calculi; Male; Spondylitis; Tomography, X-Ray Computed; Treatment Outcome

Drug-induced nephrolithiasis contributes to 1-2% of the incidence of renal calculi. We examined whether ceftriaxone at therapeutic doses could be crystallized in the urine and also explored its role in kidney stone formation. Crystallization was induced by mixing ceftriaxone sodium at therapeutic urinary excretion levels (0.5-4.0 mg/ml) to calcium chloride at physiologic urinary concentration (5mM) in deionized (dI) water or artificial urine (AU). The results showed that ceftriaxone was crystallized with free calcium in dose- and time-dependent manner. These ceftriaxone/calcium crystals showed birefringence property under polarized microscope. Individual crystals had needle-shape (5-100 μm in length), whereas the aggregated form had star-burst and irregular-plate shape (40-200 μm in diameter) (note that the crystal sizes were much larger than renal tubular lumens). Calcium-depletion assay revealed that crystallization required free calcium as a substrate. In AU, crystallization remained although it was partially inhibited when compared to that in dI water. Finally, these crystals could tightly adhere onto renal tubular cell surface. Our data demonstrated that ceftriaxone at therapeutic levels could be crystallized with free calcium in the urine under physiologic condition. We hypothesize that tubular occlusion and crystal-cell adhesion may play important role in pathogenic mechanisms of ceftriaxone-induced nephrolithiasis.

Topics: Animals; Anti-Bacterial Agents; Calcium; Ceftriaxone; Cell Adhesion; Cell Line; Crystallization; Dogs; Humans; Kidney Calculi; Nephrolithiasis

Topics: Abdominal Pain; Adult; Anti-Infective Agents; Ceftriaxone; Constipation; Diagnosis, Differential; Female; Humans; Kidney Calculi; Metronidazole; Nephrostomy, Percutaneous; Pleural Effusion; Potassium Chloride; Radiography; Urinoma; Young Adult

Topics: Acute Disease; Anti-Bacterial Agents; Ceftriaxone; Child; Escherichia coli Infections; Humans; Kidney; Kidney Calculi; Male; Pyelonephritis; Ultrasonography

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Dose-Response Relationship, Drug; Humans; Kidney Calculi; Prospective Studies; Risk Factors

Ceftriaxone, a third generation cephalosporin, is widely used for treating infection during childhood. The kidneys eliminate approximately 33-67% of this agent, and the remainder is eliminated via the biliary system. Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone associated nephrolithiasis develops by the same mechanism, and whether this condition is dose related.. The study involved 51 children with various infections. Of these, 24 were hospitalized with severe infection and received 100 mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27 patients received a single daily intramuscular injection of 50 mg/kg/day. Serum and urine parameters were evaluated before and after treatment, and abdominal ultrasonographic examinations were also carried out before and after treatment.. Serum urea, creatinine, and calcium levels were normal in all patients before and after treatment. Post-treatment ultrasound identified nephrolithiasis in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm). Comparison of the groups with and without nephrolithiasis revealed no significant differences with respect to age, sex distribution, duration of treatment, or dose/route of administration of ceftriaxone. The renal stones disappeared spontaneously in three of the four cases, but were still present in one patient 7 months after ceftriaxone treatment.. Conclusions: The study showed that children taking a 7 day course of normal or high dose ceftriaxone may develop small sized asymptomatic renal stones. The overall incidence of nephrolithiasis in this study was 7.8%.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hospitalization; Humans; Infant; Kidney Calculi; Male; Prospective Studies; Ultrasonography

Ceftriaxone is a widely used third-generation cephalosporin. It is generally very safe, but complications of biliary pseudolithiasis and, rarely, nephrolithiasis have been reported in children. These complications generally resolve spontaneously with cessation of the ceftriaxone therapy; however, they may symptomatically mimic more serious clinical problems, such as cholecystitis. We report a case of both ceftriaxone-induced biliary pseudolithiasis and nephrolithiasis.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Epidural Abscess; Gallstones; Humans; Kidney Calculi; Male

Drug-induced urinary calculi are rarely observed. However, it is useful to know this etiology. A complete anamnesis of drugs and dosages is mandatory if a patient presents with lithiasis, since some pharmacotherapies may carry an enhanced lithogenic risk. The list of lithogenic drugs is discussed. In order to yield preventive data, infrared, spectrophotometry is the best available analytic method.

Topics: Allopurinol; Antacids; Ascorbic Acid; Calcium; Cathartics; Ceftriaxone; Humans; Kidney Calculi; Medical History Taking; Quinolones; Substance-Related Disorders; Sulfonamides

Topics: Adolescent; Ceftriaxone; Humans; Kidney Calculi; Male