Acute Renal failure with Ciprofloxacin Overdose: Spectrum of Renal Pathology
Abstract
Ciprofloxacin is a commonly used fluoroquinolone despite evidence of increased resistance. Acute interstitial Nephritis secondary to ciprofloxacin usage is a well-known entity at therapeutic
dosages. Literature review shows scant reports of renal failure secondary to overdose of ciprofloxacin. Here we report a 50 year old male patient who presented as an emergency with anuria and renal failure 4 days after ingestion of 20 tablets of ciprofloxacin. Renal biopsy revealed granulomatous interstitial nephritis, acute tubular necrosis and crystals in the tubular lumen.
Acute Interstitial nephritis is the most common biopsy feature of Ciprofloxacin induced renal failure. Isolated findings of acute tubular necrosis, granulomatous interstitial nephritis and crystals
in the tubular lumen have also been reported. This case is unique for the presence of all three pathological findings.
References
2007;56(8)1131-1132.
2. Lockhart SR, Abramson MA, Beekmann SE, Gallagher G, Riedel S, Diekema DJ, Quinn JP, Doern GV. Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol. 2007;45(10):3352-9.
3. Dharnidharka VR, Nadeau K, Cannon CL, Harris HW, Rosen S. Ciprofloxacin overdose: acute renal failure with prominent apoptotic changes. Am J Kidney Dis. 1998;31(4):710
4. George MJ, Dew RB 3rd, Daly JS. Acute renal failure after an overdose of ciprofloxacin. Arch Intern Med. 1991;51(3):620.
5. Bailey JR, Trott SA, Philbrick JT. Ciprofloxacin-induced acute interstitial nephritis. Am J Nephrol. 1992;12(4):271- 3
6. Hootkins R, Fenves AZ, Stephens MK. Acute renal failure secondary to oral ciprofloxacin therapy: a presentation of three cases and a review of the literature. Clin Nephrol. 1989;32(2):75-8.
7. Lim S, Alam MG. Ciprofloxacin-induced acute interstitial nephritis and autoimmune hemolytic anemia. Ren Fail. 2003;25(4):647-51.
8. Reece RJ, Nicholls AJ. Ciprofloxacin-induced acute interstitial nephritis. Nephrol Dial Transplant. 1996;11(2):393.
9. Rippelmever DJ, Synhavsky A. Ciprofloxacin and allergic interstitial nephritis. Ann Intern Med. 1988; 109(2):170
10. Lien YH, Hansen R, Kern WF, Bangert J, Nagle RB, Ko M, Siskind MS. Ciprofloxacin-induced granulomatous interstitial nephritis and localized elastolysis. Am J Kidney Dis.1993;22(4):598-602.
11. Shih DJ, Korbet SM, Rydel JJ, Schwartz MM. Renal vasculitis associated with ciprofloxacin. Am J Kidney Dis. 1995;26(3):516-9.
12. Storsley L, Geldenhuys L. Ciprofloxacin-induced ANCAnegative cutaneous and renal vasculitis-resolution with drug withdrawal. Nephrol Dial Transplant. 2007;22:660-672.
13. Sedlacek M, Suriawinata AA, Schoolwerth A , Remillard BD. Ciprofloxacin crystal nephropathy—a ‘new’ cause of acute renal failure. Nephrol Dial Transplant. 2006 ;21(8):2339-40.
14. Stratta P, Lazzarich E, Canavese C, Bozzola C, Monga G. Ciprofloxacin crystal nephropathy. Am J Kidney Dis. 2007;50(2):330-5.
15. Chopra N, Fine PL, Price B, Atlas I. Bilateral hydronephrosis from ciprofloxacin induced crystalluria and stone formation. J Urol. 2000 Aug;164(2):438.
16. Muriithi AK, Leung N, Valeri AM, Cornell LD, Sethi S, Fidler ME, Nasr SH. Biopsy-Proven Acute Interstitial Nephritis. 1993-2011: A Case Series. Am J Kidney Dis. 2014;64(4):558-
566.