Abstract: TH-PO065
Ciprofloxacin Crystal-Induced Acute Tubular Injury: A Case Series
Session Information
- AKI: Liver Disease, Nephrotoxicity, Novel Therapeutics
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Chalmers, Dustin R., LSU Internal Medicine Residency Baton Rouge, Baton Rouge, Louisiana, United States
- Sharma, Sakshi, Ochsner Medical Center, New Orleans, Louisiana, United States
- Ramanand, Akanksh, Ochsner Medical Center, New Orleans, Louisiana, United States
- Kanduri, Swetha Rani, Ochsner Medical Center, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States
Background
Ciprofloxacin crystal-induced acute tubular injury (ATI) is a rare etiology of acute kidney injury (AKI) characterized by precipitation of ciprofloxacin crystals in the kidney tubules causing obstruction and tubular damage. Ciprofloxacin crystalluria is often seen in these cases. However, most of the available evidence comes from isolated case reports. We aimed to compile a series of cases in which ciprofloxacin crystal-induced ATI was the presumed cause of ATI.
Methods
We prospectively collected demographic and clinical data of patients seen in inpatient nephrology consultation who had a urine specimen subjected to microscopic examination of the urinary sediment (MicrExUrSed) as part of the clinical evaluation over 5 years. We identified cases in which ciprofloxacin crystalluria was identified by MicrExUrSed, recent exposure to ciprofloxacin was confirmed, and ciprofloxacin crystal-induced ATI was considered the likely cause of AKI without a possible alternative diagnosis. Urinary ciprofloxacin crystals were identified based on morphology under direct bright field light microscopy and polarized light.
Results
Of 747 AKI cases who underwent MicrExUrSed, we identified 6 cases in which ciprofloxacin crystal-induced ATI was the most likely cause of AKI. The morphology of the identified crystals was consistent across all cases. Median age was 63 (41-79), 4 were women, all 6 were white. None had preexisting CKD, 2 had cirrhosis. Mean number of days from initiation of ciprofloxacin to onset of AKI was 4 (1-12). The route of ciprofloxacin was 3 oral, and 3 IV. Urinary pH averaged 5.3. Mean serum creatinine at presentation was 2.6 (1.2-4.7) mg/dL. One patient developed concomitant shock which could have contributed to the AKI. Four patients needed dialysis. One patient returned to baseline renal function upon discharge and 3 patients died or were discharged to hospice.
Conclusion
Ciprofloxacin crystal-induced ATI should be suspected in individuals who present with AKI shortly after initiation of ciprofloxacin. This case series demonstrates the utility of MicrExUrSed under direct bright field light microscopy and polarized light as a diagnostic tool to aid in the diagnosis of AKI. Further studies are needed to correlate ciprofloxacin crystalluria with pathological evidence of crystal-induced ATI.
Funding
- Other U.S. Government Support