A Case of Acute Kidney Injury after Contrast Imaging and Empiric Nephrotoxic Antibiotherapy

Introduction: Contrast imaging assists with a diagnosis and antibiotics are essential for treatment of complicated infections. Since empiric antibiotherapy and multiple contrast imaging in critically ill children can cause acute kidney injury (AKI), clinicians must pay special attention in this critical decision process.

Presentation of Case: Six-year-old boy had a penetrating trauma via a scythe to his right eye with resultant orbital cellulitis and endopthalmitis. He received multiple empiric nephrotoxic antimicrobial therapy and his orbit was imaged three times with radio-contrast studies in a week. He admitted to pediatric intensive care unit (PICU) with resultant renal failure. The patient survived with normal renal functions by the help of intensive care support including mechanical ventilation, inotropic therapy, renal replacement therapy, surgical intervention, and proper antibiotic dosage with daily adjustments per calculated glomerular filtration rate.

Conclusion: Special consideration must be given when using empiric antibiotics and imaging with contrast media in sick children. Both may deteriorate renal functions as in our patient. These predictors, however, need further work to validate reliability.