title: Ceftriaxone and acute renal failure in children.
abstract: OBJECTIVE
  Our aim was to evaluate the clinical profile, treatment, and outcome of ceftriaxone-associated postrenal acute renal failure (PARF) in children.
  
  
  METHODS
  We retrospectively studied 31 consecutive cases from 2003 to 2012 for PARF after ceftriaxone treatment. There was no past history of urolithiasis or nephropathy in these children.
  
  
  RESULTS
  The average time of ceftriaxone administration before PARF was 5.2 days. The major symptoms apart from anuria included flank pain (>3 years old, 25/25), excessive crying (<3 years, 6/6), and vomiting (19/33). Ultrasound showed mild hydronephrosis (25/31) and ureteric calculi (11/31). Nine children recovered after 1 to 4 days of pharmacotherapy. Twenty-one children who were resistant to pharmacotherapy underwent retrograde ureteral catheterization. After catheterization of their ureters, normal urine flow was observed, and the symptoms subsided immediately. Catheter insertion failed in 1 child who subsequently underwent 3 sessions of hemodialysis before normal urination was restored. Ceftriaxone was verified to be the main component of the calculi in 4 children by tandem mass spectrometric analysis. The recovery was complete in all cases.
  
  
  CONCLUSIONS
  Ceftriaxone therapy in children may cause PARF. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy.
authors.affiliation: Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, and.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Zhou
authors.forename: Jiyan
authors.initials: J
authors.lastname: Yuan
authors.forename: Guiying
authors.initials: G
authors.lastname: Chen
authors.forename: Hongliang
authors.initials: H
authors.lastname: Jiang
authors.forename: Wen
authors.initials: W
authors.lastname: Zhang
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone
keywords: acute renal failure; ceftriaxone; child