• Petya Bogdanova-Mihaylova, David Burke, John P O'Dwyer, David Bradley, Jennifer A Williams, Simon J Cronin, Shane Smyth, Raymond P Murphy, Sinead M Murphy, Catherine Wall, and McCabeDominick J HDJHDepartment of Neurology, Adelaide & Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland. dominick.mccabe@amnch.ie.Academic Unit of Neurology, School of Medicine, Trinity College.
• Department of Neurology, Adelaide & Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland.
• Ir J Med Sci. 2018 Aug 1; 187 (3): 777-780.

BackgroundPatients with 'suspected viral encephalitis' are frequently empirically treated with intravenous aciclovir. Increasing urea and creatinine are 'common', but rapidly progressive renal failure is reported to be 'very rare'.AimsTo describe the clinical course and outcome of cases of aciclovir-induced acute kidney injury (AKI) encountered by the Liaison Neurology Service at AMNCH and to highlight the importance of surveillance and urgent treatment of this iatrogenic complication.MethodsRetrospectively and prospectively collected data from the Liaison Neurology Service at AMNCH on patients who received IV aciclovir for suspected viral encephalitis and developed AKI were analysed. Aciclovir-induced AKI was defined by a consultant nephrologist in all cases as a rise in serum creatinine of > 26 μmol/L in 48 h or by ≥ 1.5 times the baseline value. Renal function, haematocrit, and fluid balance were monitored following AKI onset.ResultsData from 10 patients were analysed. Median time to AKI onset was 3.5 days (range: 1-6 days). Aciclovir was stopped or the dose adjusted. All patients recovered with IV normal saline, aiming for a urine output > 100-150 ml/h. The interval between first rise in creatinine and return to normal levels varied between 5 and 19 days.ConclusionsLiaison neurologists and general physicians need to be aware that aciclovir may cause AKI attributed to distal intra-tubular crystal nephropathy. Daily fluid balance and renal function monitoring are essential because AKI may arise even with intensive pre-hydration. Prognosis is good if identified early and actively treated.

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