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Background <p>Tosufloxacin (TFLX), a fluoroquinolone, is widely used in Japanese children with macrolide-resistant <i>Mycoplasma pneumoniae</i> infection. Acute kidney injury (AKI) associated with TFLX has been reported, often with urinary drug crystals; however, its incidence and clinical characteristics remain unclear.</p> Methods <p>In this multicenter retrospective study, we included 227 children (2–15&#xa0;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.</p> Results <p>At 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 &lt; 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.</p> Conclusions <p>Our 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.</p> Graphical abstract <p></p>

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Acute kidney injury and urinary drug crystals in children treated with tosufloxacin: a multicenter retrospective study

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Yuji Matsumoto,
  • Masato Itano,
  • Takuma Ando,
  • Tomomi Kondoh,
  • Soichiro Ishimaru,
  • Yoshiki Kawamura,
  • Hidetaka Nakai,
  • Masayuki Hirai,
  • Satoru Kisohara,
  • Naonori Kumagai,
  • Yohei Ikezumi

摘要

Background

Tosufloxacin (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.

Methods

In 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.

Results

At 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.

Conclusions

Our 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.

Graphical abstract