tetracycline and Polycystic-Kidney-Diseases

Tetracyclines are broad-spectrum antibiotics used by dental practitioners in the treatment of periodontal disease. They generally are safe in adults. However, caution is advised in patients who have pre-existing kidney disease.. A 42-year-old woman with polycystic kidney disease received a prescription for tetracycline (250 milligrams, four times daily) after undergoing tooth extractions. She developed nausea, vomiting and diarrhea within days and end-stage renal disease within two weeks of taking the antibiotic. Hemodialysis was required to stabilize the patient's condition. Use of the Naranjo nomogram demonstrated an association between the two events.. This case illustrates the importance of obtaining a thorough medical history and understanding potential adverse drug effects before prescribing a common antibiotic.

Topics: Adult; Alveolar Bone Loss; Anti-Bacterial Agents; Dental Care for Chronically Ill; Female; Humans; Kidney Failure, Chronic; Polycystic Kidney Diseases; Renal Dialysis; Renal Insufficiency, Chronic; Tetracycline; Tooth Extraction

Compounds from 16 classes of antimicrobial drugs were tested for their abilities to inhibit the in vitro multiplication of nanobacteria (NB), a newly discovered infectious agent found in human kidney stones and kidney cyst fluids from patients with polycystic kidney disease (PKD). Because NB form surface calcifications at physiologic levels of calcium and phosphate, they have been hypothesized to mediate the formation of tissue calcifications. We describe a modified microdilution inhibitory test that accommodates the unique growth conditions and long multiplication times of NB. This modified microdilution method included inoculation of 96-well plates and determination of inhibition by periodic measurement of the absorbance for 14 days in cell culture medium under cell culture conditions. Bactericidal or bacteriostatic drug effects were distinguished by subsequent subculture in drug-free media and monitoring for increasing absorbance. NB isolated from fetal bovine serum (FBS) were inhibited by tetracycline HCl, nitrofurantoin, trimethoprim, trimethoprim-sulfamethoxazole, and ampicillin at levels achievable in serum and urine; all drugs except ampicillin were cidal. Tetracycline also inhibited multiplication of isolates of NB from human kidney stones and kidney cyst fluids from patients with PKD. The other antibiotics tested against FBS-derived NB either had no effect or exhibited an inhibitory concentration above clinically achievable levels; the aminoglycosides and vancomycin were bacteriostatic. Antibiotic-induced morphological changes to NB were observed by electron microscopy. Bisphosphonates, aminocaproic acid, potassium citrate-citric acid solutions, and 5-fluorouracil also inhibited the multiplication of NB in a cidal manner. Insights into the nature of NB, the action(s) of these drugs, and the role of NB in calcifying diseases may be gained by exploiting this in vitro inhibition test system.

Topics: Anti-Bacterial Agents; Bacteria; Diphosphonates; Fluorouracil; Kidney Calculi; Microbial Sensitivity Tests; Microscopy, Electron; Polycystic Kidney Diseases; Tetracycline

Topics: Adolescent; Adult; Ampicillin; Azathioprine; Bacteriuria; Cadaver; Female; Glomerulonephritis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Polycystic Kidney Diseases; Prednisone; Pyelonephritis; Recurrence; Tetracycline; Transplantation, Homologous; Ureteral Obstruction; Urinary Catheterization; Urinary Tract Infections