Avci Z, Koktener A, Uras N, Catal F, Karadag A, Tekin O, Degirmencioglu H, Baskin E
Department of Pediatrics, Faculty of Medicine, Bakent University, Ankara, Turkey.
Arch Dis Child. 2004 Nov;89(11):1069-72. doi: 10.1136/adc.2003.044156.
Ceftriaxone, a third generation cephalosporin, is widely used for treating infection during childhood. The kidneys eliminate approximately 33-67% of this agent, and the remainder is eliminated via the biliary system. Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone associated nephrolithiasis develops by the same mechanism, and whether this condition is dose related.
The study involved 51 children with various infections. Of these, 24 were hospitalized with severe infection and received 100 mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27 patients received a single daily intramuscular injection of 50 mg/kg/day. Serum and urine parameters were evaluated before and after treatment, and abdominal ultrasonographic examinations were also carried out before and after treatment.
Serum urea, creatinine, and calcium levels were normal in all patients before and after treatment. Post-treatment ultrasound identified nephrolithiasis in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm). Comparison of the groups with and without nephrolithiasis revealed no significant differences with respect to age, sex distribution, duration of treatment, or dose/route of administration of ceftriaxone. The renal stones disappeared spontaneously in three of the four cases, but were still present in one patient 7 months after ceftriaxone treatment.
Conclusions: The study showed that children taking a 7 day course of normal or high dose ceftriaxone may develop small sized asymptomatic renal stones. The overall incidence of nephrolithiasis in this study was 7.8%.
头孢曲松是第三代头孢菌素，广泛用于治疗儿童期感染。该药物约33%-67%经肾脏排泄，其余经胆道系统排泄。头孢曲松可能与钙离子结合形成不溶性沉淀，导致胆汁假性结石形成。本研究的目的是评估头孢曲松相关肾结石是否通过相同机制形成，以及这种情况是否与剂量有关。
本研究纳入51例患有各种感染的儿童。其中，24例因严重感染住院，接受每日100mg/kg头孢曲松，分两次等量静脉注射。另外27例患者每日单次肌肉注射50mg/kg。在治疗前后评估血清和尿液参数，并在治疗前后进行腹部超声检查。
所有患者治疗前后血清尿素、肌酐和钙水平均正常。治疗后超声检查发现51例受试者中有4例（7.8%）患有肾结石。结石均较小（2mm）。有肾结石和无肾结石组在年龄、性别分布、治疗持续时间或头孢曲松的剂量/给药途径方面无显著差异。4例中有3例肾结石自发消失，但1例患者在头孢曲松治疗7个月后仍有结石。
本研究表明，接受7天常规或高剂量头孢曲松治疗的儿童可能会出现无症状的小肾结石。本研究中肾结石的总体发生率为7.8%。
