• nephrology
• pharmacology

Drug-induced kidney injury is one of the most common causes of acute kidney injury (AKI) in children. As well as induction of AKI, drug-induced nephrotoxicity can also affect long-term renal function and lead to chronic kidney disease (CKD) and end-stage renal disease.1

Sandery et al 2 present the results of a well-conducted retrospective cohort study in which they describe AKI incidence and associated risk factors related to intravenous aciclovir in children over a 12-month period at two children’s hospitals in Australia. It is the first study to report AKI using the Kidney Disease Improving Global Outcomes (KDIGO) criteria in children exposed to aciclovir. AKI was reported in 18% of children (27/150). This is comparable with reported rates in adults, and lower than the 35% previously reported in children using the modified Paediatric Risk Injury, Failure, Loss, End-Stage Renal Disease criteria.3

Overall, those who developed AKI had a longer treatment duration and cumulative dose of aciclovir than those who did not develop AKI. Oncology patients (OR 3.4, 95% CI 1.5 to 8.2) and those with an elevated baseline estimated glomerular filtration rate (eGFR >120 mL/min/1.73 m²) (OR 3.6, 95% CI 1.3 to 10.1) had increased odds of developing AKI. However, a logistic regression including all these factors identified only elevated baseline eGFR as an independent variable associated with AKI.

Their finding of elevated baseline eGFR as a risk factor for AKI is a …