Ceftriaxone-associated renal toxicity in adults: a case report and recommendations for the management of such cases.

WHAT IS KNOWN AND

OBJECTIVE

Ceftriaxone is a third-generation cephalosporin with broad-spectrum antibacterial activity. Ceftriaxone-associated urolithiasis and post-renal acute renal failure (PARF) in adults is exceedingly rare and perhaps underappreciated. We report one such case to increase appreciation of this risk and provide recommendations for its management based on our experience and a review of other similar cases.

CASE SUMMARY: A 25-year-old male suddenly developed colicky abdominal pain, anuria and bilateral renal colic during intravenous ceftriaxone administration. Investigations showed elevated serum creatinine,urinary tract ultrasound revealed bilateral mild hydronephrosis and proximal ureterectasia,abdominal enhanced computed tomography (CT) revealed that bilateral ureteropyelectasia and contrast medium failed to fill bilateral pelvises and ureters. This patient failed to respond to pharmacotherapy. Symptoms were resolved and renal function normalized following double J stent insertions by cystoscopy.

WHAT IS NEW AND

CONCLUSION

Overdose administration of ceftriaxone was related to urolithiasis and PARF in adults. MDCT and MIP were efficient and effective in identifying ceftriaxone-associated urolithiasis.Treatment should be optimized, including prompt J stent insertions by cystoscopy.