What can cause meningitis and Acute Kidney Injury (AKI)?

From the Guidelines

Meningitis and acute kidney injury (AKI) can be caused by several overlapping factors, including bacterial infections, viral infections, fungal pathogens, certain medications, and autoimmune conditions, with bacterial infections like Neisseria meningitidis being a common cause of both conditions, as seen in the UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.

Causes of Meningitis and AKI

• Bacterial infections, particularly from Streptococcus pneumoniae, Neisseria meningitidis, and Listeria monocytogenes, are common causes of meningitis that can simultaneously trigger AKI through sepsis, dehydration, or direct kidney damage.
• Viral infections like herpes simplex virus, enteroviruses, and HIV can cause both conditions.
• Fungal pathogens such as Cryptococcus and Candida may lead to meningitis with concurrent kidney injury, especially in immunocompromised patients.
• Certain medications used to treat infections, including some antibiotics like vancomycin and aminoglycosides, can cause nephrotoxicity while treating meningitis.
• Autoimmune conditions such as lupus can affect both the central nervous system and kidneys.
• Severe dehydration from the fever, vomiting, and reduced fluid intake associated with meningitis can independently precipitate AKI, as highlighted in the COVID-19 and acute kidney injury in hospital guidelines 1.

Treatment and Management

• Treatment depends on identifying the underlying cause, with bacterial meningitis typically requiring immediate broad-spectrum antibiotics like ceftriaxone (2g IV every 12 hours) and vancomycin (15-20 mg/kg IV every 8-12 hours), adjusted for kidney function, while maintaining adequate hydration and monitoring kidney parameters closely.
• Maintaining optimal fluid status (euvolaemia) is critical in reducing the incidence of AKI, as emphasized in the COVID-19 guidelines 1.
• Regular assessments of fluid status and fluid management plans are necessary, and in those who need intravenous fluids, the choice of replacement fluid should be based on patients’ biochemistry and fluid status.

From the FDA Drug Label

MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae Ceftriaxone for Injection has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis and Escherichia coli.

Meningitis and Acute Kidney Injury (AKI) Causes:

• Bacterial infections caused by Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, Staphylococcus epidermidis, or Escherichia coli can lead to meningitis.
• There is no direct information in the provided drug labels about the causes of AKI. 2

From the Research

Causes of Meningitis and AKI

• Bacterial meningitis is a medical emergency that can cause AKI, with bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and Streptococcus agalactiae being common causes 3, 4
• Sepsis is a major cause of AKI in ICU patients, and septic AKI is the most common AKI syndrome in ICU, accounting for approximately half of all AKI cases 5, 6
• The pathogenesis of AKI in sepsis is probably related to cytotoxic effects of inflammation, and impaired microcirculation, as well as hyperglycaemia, and antimicrobial agent-induced drug nephrotoxicity 6
• Acute tubular necrosis, caused by either ischemia or nephrotoxicity, is a common cause of AKI 7

Risk Factors for Meningitis and AKI

• Patients with risk factors for Listeria meningitis, such as immunocompromised individuals, are at increased risk of developing AKI 3
• AKI patients are at greater risk for infection as a result of volume overload, dialysis catheter insertion and secondary manipulation, inflammation of the kidneys leading to 'organ cross talk', and impaired host immunity 6
• The use of starch-containing fluids and chloride-rich fluids can decrease renal function and increase the risk of AKI 5

Diagnosis and Management of Meningitis and AKI

• The diagnosis of AKI remains based on clinical assessment and measurement of urinary output and serum creatinine, with multiple biomarkers and especially cell cycle arrest biomarkers gaining acceptance 5
• The diagnosis of bacterial meningitis is based on the interpretation of cerebrospinal fluid parameters, and international and local guidelines differ with regard to initial empirical therapy 3
• Dexamethasone should be a routine component of empirical therapy for bacterial meningitis due to its proven role in reducing morbidity and mortality from pneumococcal meningitis 3