Polymicrobial therapy induced nephrotoxicity: more is not always better

Ankit R. Mistry, Sapna D. Gupta, Supriya D. Malhotra


Polymicrobial induced nephrotoxicity (PIN) occurs more commonly in critically ill patients. Exposure to drugs often results in toxicity in kidney which represents a major control system maintaining homeostasis of body and thus is especially susceptible to xenobiotics. We present here an adverse drug reaction which is additive nephrotoxicity with combined antimicrobial use in critically ill patient. Blood urea and serum creatinine levels were raised much above the baseline after a fortnight of therapy. The suspected drugs were withdrawn leading to a gradual improvement and normalization of blood urea and serum creatinine levels This suggested a causal relationship which was possibly due to the administration of nephrotoxic antimicrobials. The present case highlights that critically ill patients on prolonged Polymicrobial therapy should be closely monitored, and dose increments should be made cautiously.


Acute kidney injury, Critically ill, Xenobiotics, Serum trouh level, Nephrotoxic drugs, Polymicrobial induced nephrotoxicity

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Nation RL, Rigatto MHP, Falci DR, Zavascki AP. Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity. Antibiotics (Basel). 2019;8(1):24.

Kim SY, Moon A. Drug-induced nephrotoxicity and its biomarkers. Biomol Ther (Seoul). 2012;20(3):268-72.

Ochoa PS, Terrell BT. A case of acute kidney injury with vancomycin and piperacillin/tazobactam. MOJ Clin Med Case Rep. 2017;7(5):297-9.

Fatemeh GS, Farahnak A. Drug-induced renal disorders. J Renal Inj Prev 2015;4(3): 57-60.

Shirali A, Pazhayattil GS. Drug-induced impairment of renal function. Int J Nephrol Renovascular Dis. 2014;457.

Oktem F, Arslan MK, Ozguner F, Candir O, Yilmaz HR, Ciris M, et al. In vivo evidences suggesting the role of oxidative stress in pathogenesis of vancomycin induced nephrotoxicity: Protection by erdosteine. Toxicol. 2005;215:227-33.

Oliveira JF, Cipullo JP, Burdmann EA. Aminoglycoside nephrotoxicity. Braz J Cardiovasc Surg. 2006;21:444-52

P. David Rogers and Damian J. Krysan. Antifungal Agents. In: Brunton LB, Lazo JS, Parker KL, eds.Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw-Hill; 2018:1087-9.