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Ir J Med Sci. 2018 Aug;187(3):777-780. doi: 10.1007/s11845-017-1728-3. Epub 2018 Jan 6.

Aciclovir-induced acute kidney injury in patients with 'suspected viral encephalitis' encountered on a liaison neurology service.

Author information

1
Department of Neurology, Adelaide & Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland.
2
Department of Neurology, Imperial College Healthcare NHS Trust, London, UK.
3
Department of Neurology, St James's Hospital, Dublin, Ireland.
4
Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
5
Department of Neurology, Cork University Hospital, Cork, Ireland.
6
Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
7
Stroke Service, AMNCH, Dublin, Ireland.
8
Department of Renal Medicine, Trinity Health Kidney Centre, AMNCH, Dublin, Ireland.
9
Department of Neurology, Adelaide & Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland. dominick.mccabe@amnch.ie.
10
Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland. dominick.mccabe@amnch.ie.
11
Stroke Service, AMNCH, Dublin, Ireland. dominick.mccabe@amnch.ie.
12
Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK. dominick.mccabe@amnch.ie.
13
Department of Neurology, Vascular Neurology Research Foundation, AMNCH, Dublin, Ireland. dominick.mccabe@amnch.ie.

Abstract

BACKGROUND:

Patients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'.

AIMS:

To describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication.

METHODS:

Retrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 μmol/L in 48 h or by ≥ 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset.

RESULTS:

Data from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days.

CONCLUSIONS:

Liaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.

KEYWORDS:

Aciclovir; Acute kidney injury; Crystal nephropathy; Viral encephalitis

PMID:
29307101
DOI:
10.1007/s11845-017-1728-3
[Indexed for MEDLINE]

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