Background: There has been a recent increase in the number of reported cases of acute renal failure (ARF) in cystic fibrosis (CF). We sought to determine the incidence risk of ARF in patients with CF in the UK and to identify possible aetiological factors.
Methods: We asked all doctors working at UK CF Centres if they had been involved with the management of a patient with CF who had developed ARF. Those responding positively were asked to request informed consent for entry into the study. The patient's case notes were then reviewed by a researcher. We restricted the analysis to patients developing ARF between 1997 & 2004. A second questionnaire sought information on aminoglycoside prescribing practice.
Results: Responses were received from 55/56 centres, with 64 reports in 1997-2004, and 9 duplicates, leaving 55 cases. Consent was obtained for data extraction in 26 cases, of which 24 fitted our criteria for ARF (verified data). Median age at presentation with ARF was 9.7 years (range 0.4 - 31.8) and 12 cases were male. The incidence risk of ARF was between 4.6 (verified data) and 10.5 cases (all data) / 10,000 CF patients / year. In 21 cases (88%) an aminoglycoside was prescribed at onset of ARF or in the preceding week. Sixteen (76%) of those receiving an aminoglycoside had gentamicin. A renal biopsy was performed in 7 cases and in 6 histological examination revealed acute tubular necrosis. Each of these latter cases had received gentamicin. Renal dialysis was required in 13 cases (54%). A compete recovery was seen in 22/24 (92%) patients (normotensive and not requiring dialysis at follow up).
Conclusions: There is increasing recognition of ARF in patients with CF and there is a significant morbidity with the majority of patients requiring dialysis. This study implicates intravenous aminoglycosides, particularly gentamicin, in the aetiology of ARF in CF. We plan to test this hypothesis in a forthcoming case control study.
- acute renal failure
- cystic fibrosis
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