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Acute kidney injury following intravenous acyclovir in children
  1. Blake J Sandery1,2,
  2. Jonathan H Erlich3,4,
  3. Sean E Kennedy1,2
  1. 1 Nephrology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  2. 2 School of Women's and Children's Health, University of New South Wales - Randwick Campus, Randwick, New South Wales, Australia
  3. 3 Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Department of Nephrology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  1. Correspondence to Dr Blake J Sandery, Nephrology, Sydney Children's Hospital Randwick, Randwick, NSW 2031, Australia; blake.sandery{at}


Objective The objective of this study was to describe the incidence of acute kidney injury (AKI) in children receiving intravenous acyclovir and determine risk factors that may be associated with it.

Design This was a retrospective cohort study, conducted by chart review.

Setting The study was conducted across two paediatric hospitals.

Patients All inpatients that received intravenous acyclovir in records from January 2015 to December 2015 were reviewed. Only patients with creatinine measurements taken before and after starting acyclovir were included in the study.

Main outcome measures The main outcome measure was the development of AKI following intravenous acyclovir administration, with AKI defined according to change in serum creatinine.

Results 150 patients were included in the analysis. Patients’ ages ranged from 2 days to 18.6 years. 27 children (18%) developed at least stage 1 AKI. Children receiving cancer treatment developed AKI more frequently than children with other diagnoses; 29.3% vs 10.9% (OR 3.4, 95% CI 1.5 to 8.2, p=0.008). The baseline estimated glomerular filtration rate (eGFR) was higher in those children who developed AKI. 34% of children had an eGFR >120 mL/min/1.73 m2 prior to acyclovir use. 31% of these children developed AKI compared with only 11% of those with a normal baseline eGFR (OR 3.6, 95 CI 1.3 to 10.1, p=0.02). Baseline eGFR was a significant predictor of AKI in a multivariable analysis that included cumulative dose and treatment duration (OR 1.02, p=0.013).

Conclusion AKI following intravenous acyclovir exposure is common in children. This study raises the possibility that glomerular hyperfiltration is a previously unrecognised risk factor for acyclovir-induced AKI.

  • nephrology
  • general paediatrics
  • therapeutics

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  • Contributors BJS contributed substantially to project planning, data collection, data analysis and manuscript writing. JHE contributed substantially to project planning, revisions, and manuscript editing. SEK contributed substantially to project planning, ethics approval, data collection, data analysis and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained via the local Human Research Ethics Committee with the approval number QIE-2016-03-05.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Individual participant data that underlie the results reported in this article will be available, after de-identification (text, tables, and figures). Data will be available from 9 months after the publication date, until 5 years after the publication date. Data will be available to researchers whose proposed use of data has been approved by an independent review committee, for the purposes of meta-analysis. Proposals should be submitted to Blake Sandery – ORCID 0000-0001-5264-9694.

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