Abstract: TH-PO119
Incidence of Amoxicillin-Induced Crystal Nephropathy
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Augusto, Jean francois, CHU Angers, Angers, France
- Brilland, Benoit, CHU d'Angers, Angers, France
- Wacrenier, Samuel, CHU Angers - CH Le Mans, Angers, France, France
- Subra, Jean-Francois, CHU Angers, Angers, France
- Garnier, Anne-Sophie, Angers University Hospital, Angers, France
Background
Amoxicillin (AMX)-induced crystal nephropathy (AICN) has been considered as a rare complication of high dose intravenous AMX. However, in the recent years, its incidence seems to be increasing. Occurrence of AICN has been observed exclusively with intravenous (IV) administration and mostly under daily doses over 8 g/day. AMX cristalluria is a major diagnostic criterion but is rarely performed by practitioners. Thus, the real incidence of AICN may be underestimated. The objective the present study was to determine the incidence of AICN in the current practice.
Methods
We conducted a retrospective study between the 01/01/2015 and 01/01/2018 in Angers University Hospital. Inclusion criteria were admission in Angers University Hospital, age over 18 years-old, and administration of more than 8g/day of AMX using IV route for more than 24h. Patients admitted directly into the intensive care units were excluded. Medical records of patients that developed KDOKI stage 2-3 AKI were reviewed by a nephrologist and a specialist in pharmacovigilange in a blinded fashion. AICN was retained if temporality analysis was conclusive, after exclusion of other causes of AKI, in absence of other nephrotoxic drug administration and if evaluations were concordant.
Results
During the 3 -years period of the study, 1303 patients received IV AMX for at least 24h, 358 (27.5%) were exposed to AMX doses over 8g/day and were included in the study. Patients were predominantly males (68.2%) with a mean age of 69.1 years-old. AMX was administered in surgical context in 21.5% of cases and in a medical context in 78.5% of cases. Patients received a mean dose of AMX of 11.2 g/day, representing a mean dose of 153.9 mg/Kg/day. Seventy-four patients (20.7%) developed AKI, 42 (56.8%) of KDIGO stage 2 or 3. Among patients with KDIGO 2-3 AKI, AICN diagnosis was retained in 16 (38.1%) patients, representing an incidence of 4.47% . As comparered to other AKI patients, female proportion was significantly higher in AICN group as compared to other AKI (p=0.013). As compared to non AKI patients, no prédictive factor of AICN could be identified.
Conclusion
This study suggests that AICN incidence is underestimated and may represent as much as one third of AKI developping under AMX treatment.