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.