Abstract
Patients with end-stage renal failure develop many kinds of complications during long-term dialysis treatment. Of the various complications, infections frequently occur owing to the disturbed immune response. To treat or to prevent serious infections, antibiotic therapy is often performed. Therefore we should pay attention of the many side effects of the drugs, particularly in patients with renal diseases.
Bleeding tendency, which is one of the important adverse effects of antibiotics, is due to severel causes such as thrombocytopenia, platelet dysfunction, and vitamin K deficiency.
Eight patients with chronic renal failure and two with acute renal failure in our dialysis unit devebped disturbances in blood clotting. Laboratory data disclosed hypoprothrombinemia due to vitamin K shortage. An other patient, who showed no abnormal results of hematologic examinations, had an unusual plasma prothrombin molecule. He was also suspected of having subclinical coagulopathy. In all cases, diet intake was markedly decreased after the complications of pneumonia, sepsis, and surgical operations. Moreover, antibiotics had been prescribed. In seven cases, only one antibiotic was used (CMZ, CFX, CTZ, CTM, PIPC, or LMOX). The others were treated with combinations of antibiotics such as cephems, penicillin, and aminolycosides.
Recently, the “methylthiotetrazole hypothesis” that antibiotics with a methylthiotetrazole side chain may induce vitamin K-deficient hypoprothrombinemia has been proposed by some investigators. In three of our patients, either cefmetazone (2 cases) or latamoxef (1 case) was used. These two antibiotics have the methylthiotetrazole side chain at the 3-position. For the other seven patients, however, the “non-methylthiotetrazole group” antibiotics were prescribed.
From these findings, it should be noted that vitamin K-deficient coagulopathy might occur frequently in diet-deficit patients with profound renal insufficiency who are treated by antibiotics. We must remain vigilant for the appearance of bleeding as an adverse action of antibiotics.
