Clostridium difficile causing acute renal failure: case presentation and review.
OBJECTIVE
Clostridium difficile infection is primarily a nosocomial infection but asymptomatic carriers of Clostridium difficile can be found in up to 5% of the general population. Ampicillin, cephalosporins and clindamycin are the antibiotics that are most frequently associated with Clostridium difficile-associated diarrhea or colitis. Little is known about acute renal failure as a consequence of Clostridium difficile-associated diarrhea.


METHODS
In this case report, we describe the course of Clostridium difficile-associated diarrhea in an 82-year-old patient developing acute renal failure. Stopping the offending agent and symptomatic therapy brought a rapid improvement of diarrhea and acute renal failure, full recovery was gained 18 d after admission. In a systematic review we looked for links between the two conditions.


RESULTS
The link between Clostridium difficile-associated diarrhea and acute renal failure in our patient was most likely volume depletion. However, in experimental studies a direct influence of Clostridium difficile toxins on renal duct cells could be shown.


CONCLUSIONS
Rapid diagnosis, nonspecific supportive treatment and specific antibiotic treatment, especially in the elderly, may lower excess mortality Clostridium difficile-associated diarrhea and renal failure being possible complications.
Arrich
Jasmin
J
Department of Emergency Medicine, Medical University Vienna, General Hospital, Wahringer Gurtel 18-20, A-1090, Austria.
Sodeck
Gottfried-H
GH
Sengolge
Gurkan
G
Konnaris
Christoforos
C
Mullner
Marcus
M
Laggner
Anton-N
AN
Domanovits
Hans
H
D058186:Acute Kidney Injury / Q000382:microbiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage
D000890:Anti-Infective Agents; D008795:Metronidazole