Abstract: SA-PO0340
Minocycline-Induced AKI in a Patient with CKD
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Lu, Wenxia, New York City Health and Hospitals Jacobi, New York, New York, United States
- Aung, Htun Min, New York City Health and Hospitals Jacobi, New York, New York, United States
- Acharya, Anjali, New York City Health and Hospitals Jacobi, New York, New York, United States
Introduction
Minocycline is antibiotic rarely associated with nephrotoxicity. Uptodate recommends monitoring renal function while using minocycline in renal impairment.
Case Description
A 69-year-old male with hypertension, type 2 diabetes, and CKD stage 4 (baseline serum creatinine [sCr] 3.5 mg/dL) presented for fever, chills, and poor appetite in the setting of suspected left foot cellulitis.
Patient found to have acute kidney injury (AKI) (sCr 4.4 mg/dL, serum urea 81 mg/dL) on day 1. Urine studies showed Na+<20 mEq/L and Cl- <20 mEq/L. MRI revealed severe Charcot changes in the ankle, suspicious for septic arthritis and osteomyelitis. The patient received IV normal saline 500 mL, ceftazidime, and daptomycin.
On day 2, septic shock developed, requiring brief vasopressor support. Blood culture grew Enterobacter cloacae; sCr peaked at 5.4 mg/dL. Antibiotics were switched to meropenem, after which sCr and BUN improved.
On day 8, wound culture grew Stenotrophomonas maltophilia, and minocycline 200 mg q12h oral was added.
On day 10, sCr and urea rose again (FeNa 2.4%, FeUrea 52.6%, UPCR 626 mg/g; urine microscopy negative for cells or casts, serologies workup negative, kidney ultrasound showed normal kidney size without hydronephrosis).
Minocycline-induced AKI was suspected. We recommended halving the dose, but Infectious Disease Department declined due to concerns of inefficacy against osteomyelitis. A planned two-week antibiotic holiday was initiated for bone biopsy at another hospital. After minocycline was stopped on day 13, renal function improved: sCr returned to baseline (3.5 mg/dL), and BUN fell from 113 to 59 mg/dL over ten days. Hemodialysis was not required.
Discussion
This case highlights minocycline's potential to cause clinically significant nephrotoxicity in patients with pre-existing renal impairment. It underscores the importance of appropriate drug dosing in renal failure and demonstrates a clear temporal association between minocycline administration and a reversible decline in kidney function.