Vanco induced AKI

 Q: 58 years old female is admitted to ICU with vancomycin associated Acute Kidney Injury (AKI). Vancomycin associated AKI is likely to be reversible?

A) True

B) False

Answer: A

The basic pathology is the apoptosis induced by the accumulation of vancomycin in proximal tubular epithelial cells. There are many factors that can play a part including age, weight, pre-existing kidney disease, concurrent administration of other nephrotoxic drugs. In ICU the concurrent use of loop diuretics, aminoglycosides, amphotericin B, IV contrast, and vasopressors play an important role. In this regard more and more literature is coming out on AKI due to the coadministration of vancomycin and select beta-lactams like piperacillin-tazobactam and flucloxacillin. Both of these antibiotics are highly used in ICUs with vancomycin for broad-spectrum coverage. The average timeline in the development of AKI is about a week. 

Although there is no cutoff point to predict vancomycin-related AKI, one of the highest risks is the maintenance of Vanco trough level at 15 to 20 mg/L, a common practice in severe infections. 

Fortunately, two-third of patients recover on discontinuation of the drug and with other supportive treatment.

# nephrology

#pharmacology

#toxicology

References:

1. Sinha Ray A, Haikal A, Hammoud KA, Yu AS. Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2016; 11:2132. 

2. Avedissian SN, Pais GM, Liu J, et al. Piperacillin-Tazobactam Added to Vancomycin Increases Risk for Acute Kidney Injury: Fact or Fiction? Clin Infect Dis 2020; 71:426. 

3. Hidayat LK, Hsu DI, Quist R, et al. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006; 166:2138. 

4. Carreno JJ, Kenney RM, Lomaestro B. Vancomycin-associated renal dysfunction: where are we now? Pharmacotherapy 2014; 34:1259. 

5. van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013; 57:734.