ArticlePediatric nephrology (Berlin, Germany)2026
Acute kidney injury and urinary drug crystals in children treated with tosufloxacin: a multicenter retrospective study.
Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTosufloxacin (TFLX), a fluoroquinolone, is widely used in Japanese children with macrolide-resistant Mycoplasma pneumoniae infection. Acute kidney injury (AKI) associated with TFLX has been reported, often with urinary drug crystals; however, its incidence and clinical characteristics remain unclear.
methodsIn this multicenter retrospective study, we included 227 children (2-15 years) who underwent blood and/or urine testing. AKI was defined according to KDIGO criteria. Kidney function and clinical characteristics were compared between patients with and without TFLX exposure at the initial visit and during follow-up. Among TFLX-treated patients, factors associated with AKI and urinary drug crystals were analyzed.
resultsAt the initial visit, AKI was more frequent in patients already receiving TFLX than in those not treated with TFLX (10% vs. 2.0%; p = 0.018). However, when analysis was restricted to patients in whom TFLX was newly initiated at our institutions, AKI incidence was 2.6% and not significantly different from controls. Gastrointestinal symptoms were more common in the AKI group (70% vs. 11%; p < 0.0001). Urinary drug crystals were detected with similar frequencies in the AKI and non-AKI groups (63% vs. 57%), and continuation of TFLX after crystal detection did not lead to AKI progression.
conclusionsOur findings suggest an association between TFLX exposure and creatinine elevation. We also evaluated AKI incidence among patients newly initiated on TFLX. Urinary drug crystals were frequently detected; however, crystal formation alone did not fully explain AKI development. Clinicians should be aware of the potential for AKI during TFLX therapy, particularly in patients with gastrointestinal symptoms.
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