title: Cefepime induced acute interstitial nephritis--a case report.
abstract: BACKGROUND
  Nephrotoxicity due to drugs especially beta lactams and cephalosporins has been well recognised. Cefepime is a fourth-generation cephalosporin that is widely prescribed with few severe adverse reactions reported. Although cefepime induced neurotoxicity has frequently been reported, there is yet no reported case of acute interstitial nephritis caused by this drug. We report a biopsy proven case of acute kidney injury due to acute interstitial nephritis associated with use of cefepime for treatment of mastoiditis and temporal bone osteomyelitis.
  
  
  METHODS
  A 62-year-old Caucasian female presented with symptoms of right sided mastoiditis. A brain Magnetic Resonance Imaging scan revealed presence of right sided mastoiditis with concurrent temporal bone osteomyelitis. Microbiological specimen isolated an Escherichia coli. Therapy was commenced with intravenous cefepime. After 4 weeks of therapy with intravenous cefepime she developed acute kidney injury. No other medications were taken by the patient. Urine analysis revealed non-nephrotic range proteinuria. There was no red cell casts or white cell casts. Renal biopsy confirmed acute interstitial nephritis as cause of acute kidney injury. Cefepime therapy was ceased and treatment with ciprofloxacin was given to complete the treatment course. Renal function improved only partially with conservative management without any corticosteroid use. To our knowledge this is the first report of cefepime induced interstitial nephritis.
  
  
  CONCLUSIONS
  Although cefepime has been considered to be a safe antibiotic from nephrotoxicity point, like other cephalosporins this adverse effect can occur rarely. Physicians need to be mindful of nephrotoxicity associated with its use and careful monitoring of renal parameters should be performed in patients on prolonged therapy with cefepime.
authors.affiliation: Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. kmac0605@gmail.com.
authors.forename: Kathy
authors.initials: K
authors.lastname: Mac
authors.affiliation: Department of Microbiology and Infectious Diseases, South West Sydney Pathology Services, Liverpool Hospital, Liverpool, NSW, 2170, Australia. Ruchir.Chavada@sswahs.nsw.gov.au.
authors.forename: Ruchir
authors.initials: R
authors.lastname: Chavada
authors.affiliation: Department of Medicine, Bankstown Hospital, Bankstown, NSW, 2200, Australia. Sharon.Paull@sswahs.nsw.gov.au.
authors.forename: Sharon
authors.initials: S
authors.lastname: Paull
authors.affiliation: Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. Kenneth.Howlin@sswahs.nsw.gov.au.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Howlin
authors.affiliation: Department of Renal Medicine, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia. Jeffery.Wong@sswahs.nsw.gov.au.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wong
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000473:pathology; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007677:Kidney Function Tests; D008417:Mastoiditis / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000473:pathology; D035583:Rare Diseases; D018570:Risk Assessment; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D002511:Cephalosporins; D002939:Ciprofloxacin; D000077723:Cefepime