title: Characterizing ceftriaxone-induced urolithiasis and its associated acute kidney injury: an animal study and Chinese clinical systematic review.
abstract: OBJECTIVE
  To investigate the pathophysiological process of ceftriaxone-induced urolithiasis and its associated acute kidney injury (AKI) based on an animal study and summarize the main clinical characteristics based on a Chinese clinical systematic review.
  
  
  METHODS
  Male Sprague-Dawley rats were randomly divided into five groups of six each according to different treatments including control; ceftriaxone; ceftriaxone with calcium; calcium; and ceftriaxone, calcium with citrate, respectively. The 24-h urine volume, serum creatinine (Scr) and blood urea nitrogen (BUN) were measured; kidney histological examination and stone analysis were performed. Systematic searches of the Chinese Knowledge Database were conducted for reports on ceftriaxone-induced urolithiasis and AKI. The eligibility of each full-text publication was accessed, and qualified data were extracted and reviewed.
  
  
  RESULTS
  Kidney stones and a significantly low 24-h urine volume with increased high Scr and BUN levels were found in the group that received ceftriaxone combined with calcium. Citrate was able to inhibit these biochemical changes and stone formations. A total of 161 qualified patients were included in the Chinese clinical systematic review: The proportion of ceftriaxone-induced urolithiasis was 21.1, 19.3, 19.3, 39.1 and 1.2 % for ages <3, 3-6, 7-17, 18-60 and >60 years. 72.7 % developed acute kidney injury eventually.
  
  
  CONCLUSIONS
  Ceftriaxone-induced urolithiasis was associated with a high risk of AKI. The pathophysiological process may be related to urinary obstruction and crystalline nephropathy. Citrate was able to inhibit stone formation and prevent further kidney injury.
authors.affiliation: Medical School of Nanjing University, 22#, Hankou Road, Nanjing, China.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, China.
authors.forename: Benxiang
authors.initials: B
authors.lastname: Ning
authors.affiliation: Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, 321#, Zhongshan Road, Nanjing, China.
authors.forename: Huaijun
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of TCM, 155#, Hanzhong Road, Nanjing, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Cong
authors.affiliation: Medical School of Nanjing University, 22#, Hankou Road, Nanjing, China.
authors.forename: Leqing
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Medical School of Nanjing University, 22#, Hankou Road, Nanjing, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Medical School of Nanjing University, 22#, Hankou Road, Nanjing, China.
authors.forename: Liming
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Medical School of Nanjing University, 22#, Hankou Road, Nanjing, China. sunxizhaonj@163.com.
authors.forename: Xizhao
authors.initials: X
authors.lastname: Sun
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000818:Animals; D001707:Biopsy, Needle; D002443:Ceftriaxone / Q000008:administration & dosage / Q000009:adverse effects*; D002681:China; D015331:Cohort Studies; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D011379:Prognosis; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D018570:Risk Assessment; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D052878:Urolithiasis / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D055815:Young Adult
chemical_list: D002443:Ceftriaxone
keywords: AKI; Ceftriaxone; Urolithiasis