title: Acute renal failure after topical fortified gentamicin and vancomycin eyedrops.
abstract: OBJECTIVE
  To report a case of acute renal failure after topical fortified gentamicin and vancomycin eyedrops in the treatment of endophthalmitis.
  
  
  METHODS
  A 67-year-old lady with diabetes mellitus was treated for bleb-related endophthalmitis. After intravitreal antibiotics, she was given oral ciprofloxacin, fortified gentamicin, and vancomycin eyedrops. She developed acute renal failure a few days after therapy. Blood tests and ultrasound of the urinary system were performed to investigate for the cause of the renal failure.
  
  
  RESULTS
  No apparent cause of renal failure could be identified in our patient. Autoimmune markers and ultrasound of the urinary system were unremarkable. Fortified gentamicin and vancomycin eyedrops were stopped on day 9 and 13, respectively. The renal function recovered dramatically. The gentamicin level was checked 2 days after it had been stopped, and the serum level was 0.34 mg/L. Renal function improved on supportive management without dialysis. Serum creatinine level completely normalized 2 months later.
  
  
  CONCLUSIONS
  This is the first article that demonstrated a detectable level of serum gentamicin level after usage of topical eyedrops. This is also the first article demonstrating that nephrotoxicity of topical fortified gentamicin and vancomycin eyedrops was found. The acute renal failure in our patient recovered completely after cessation of the eyedrops.
authors.affiliation: Department of Ophthalmology, Caritas Medical Centre, Hong Kong, China. rkttang@yahoo.com.hk
authors.forename: Raymond Kai Tat
authors.initials: RK
authors.lastname: Tang
authors.forename: Raymond Kwok-Kay
authors.initials: RK
authors.lastname: Tse
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D009877:Endophthalmitis / Q000188:drug therapy; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D009883:Ophthalmic Solutions; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D009883:Ophthalmic Solutions; D014640:Vancomycin