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Cerba Y, Grosjean J, Forestier E, Rogeaux O, Bally S, Croze L, Maynard C, Morel B, Philit JB, Fourcade J. [Amoxicillin induced crystal nephropathy : Monitoring of residual plasma levels]. Nephrol Ther 2021; 17:428-433. [PMID: 34034971 DOI: 10.1016/j.nephro.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
Since 2010, a lot of cases of amoxicillin induced crystal nephropathy have been reported to the French pharmacovigilance centers partly due to the high doses recommended by infectious disease guidelines. Typical clinical presentation and exclusion of others toxics or immuno-allergic causes are mandatory to assess the diagnostic. Amoxicillin crystals are rarely found or searched and renal biopsy is not frequently performed due to technical reasons and prompt renal recovery after antibiotics withdrawal. Monitoring of residual plasma concentration is rarely used in clinical practice for diagnostic or prognostic interest. We present 9 consecutive cases of acute kidney injury suspected to be due to amoxicillin crystals with residuals plasma levels to disclose a predictive threshold of tubulopathy. All patients had a high residual rate at diagnosis but we cannot find a threshold that would allow to adapt the antibiotic dose, enhance hydratation and alkalinizide urine to increase the medication solubility and limit renal toxicity.
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Affiliation(s)
- Yann Cerba
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Jérôme Grosjean
- Laboratoire d'analyses médicales, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Emmanuel Forestier
- Service d'infectiologie et médecine interne, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Olivier Rogeaux
- Service d'infectiologie et médecine interne, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Stéphane Bally
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Laure Croze
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Claire Maynard
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Bertrand Morel
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Jean-Baptiste Philit
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France
| | - Jacques Fourcade
- Service de néphrologie dialyse, CHMS Chambéry, BP 31125, 73011 Chambéry cedex, France.
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