Acute Kidney Injury Caused by Ceftriaxone-induced Urolithiasis in Children: a Single-institutional Experience in Diagnosis, Treatment and Follow-up

Purpose: To evaluate our clinical outcomes in managing acute kidney injury (AKI) resulting from ceftriaxone-induced urolithiasis with emergency treatment.

Methods: From July 2008 to July 2013, a series of 15 patients including 12 males and 3 females were admitted to our center. The mean age of them was (4.76 ± 3.74) years. A chief complaint of anuria was presented in 12 (80.0 %) patients for 13 h-4 days and that of oliguria in three (20.0 %) patients for 20 h-10 days. All of them were diagnosed of postrenal AKI resulting from ceftriaxone-induced urolithiasis and underwent emergency hospitalization.

Results: Double-J stenting with cystoscopy was successfully performed in nine patients (60.0 %), and ureteroscopy was applied in four patients (26.7 %). One patient (6.7 %) underwent unilateral double-J insertion combined with contralateral percutaneous nephrostomy, and one (6.7 %) underwent open surgery. Loose texture and sandlike stones, the main characteristics of these stones, made them excreted spontaneously after the initial treatment, whereas only one patient (6.7 %) underwent additional ureterolithotomy due to many residual calculi. Serum creatinine and blood urea nitrogen recovered to normal levels within 3 days. All specimens were collected and analyzed by infrared spectrum, with results demonstrating that the main composition was ceftriaxone calcique. All patients were followed up for 11 months-5 years (mean 33.80 ± 22.56 months). No one turned to irreversible renal failure.

Conclusions: Ceftriaxone could result in urolithiasis in children, which could also cause AKI. Appropriate and timely surgical management by conventional treatments will mostly lead to full recovery of renal functions.