Biopsy-Proven Acute Tubular Necrosis due to Vancomycin Toxicity

Abstract

Vancomycin (VAN) has been associated with acute kidney injury (AKI) since it has been put into clinical use in the 1950's. Early reports of AKI were likely linked to the impurities of the VAN preparation. With the advent of the more purified forms of VAN, the incidence of AKI related to VAN were limited to acute interstitial nephritis (AIN) or as a potentiating agent to other nephrotoxins such as Aminoglycosides. VAN as the sole etiologic factor for nephrotoxic acute tubular necrosis (ATN) has not been described. Here, we report a case of biopsy-proven ATN resulting from VAN.

Figure 1

Representative photographs of the renal biopsy showing tubular damage secondary to drug toxicity. In both panels (a) and (b) a number of tubules show moderate degree of acute tubular necrosis (asterisks). Some of tubules contain hyaline or epithelial casts in their lumina (green arrows), while several tubules show vacuolization of their cytoplasm (green arrowheads). One of the glomerular afferent arteriole shows swollen endothelia and occlusive change (black arrow).