Can Cefepime (Cefepime) cause Acute Kidney Injury (AKI)?

From the Guidelines

Cefepime can cause acute kidney injury, particularly in patients with pre-existing renal impairment or those receiving high doses. The risk of kidney injury with Cefepime is generally low in patients with normal renal function, but increases in patients with pre-existing kidney disease, older adults, and those receiving other nephrotoxic medications simultaneously 1.

Key Considerations

• The mechanism of Cefepime-induced kidney injury typically involves acute interstitial nephritis, an immune-mediated hypersensitivity reaction that causes inflammation in the kidney tissue.
• Symptoms of Cefepime-induced AKI may include decreased urine output, fluid retention, and elevated blood urea nitrogen and creatinine levels.
• Dose adjustment is necessary for patients with impaired kidney function to prevent toxicity, as recommended by guidelines from the French Society of Pharmacology and Therapeutics and the French Society of Anaesthesia and Intensive Care Medicine 1.

Prevention and Management

• If AKI is suspected during Cefepime treatment, kidney function should be monitored closely, and the drug may need to be discontinued and replaced with an alternative antibiotic.
• It is essential to be aware of the potential for neurotoxicity with Cefepime, particularly in patients with renal failure, as this can lead to severe neurological manifestations, including seizures and encephalopathy 1.
• Monitoring of plasma free concentrations of beta-lactam antibiotics, such as Cefepime, is crucial to prevent toxicity, and concentrations above eight times the MIC should be avoided 1.

From the Research

Cefepime and Acute Kidney Injury

• Cefepime, a fourth-generation cephalosporin, has been associated with acute kidney injury (AKI) in some cases, as reported in a study published in 2015 2.
• The study presented a case of a 62-year-old female who developed acute kidney injury due to acute interstitial nephritis after receiving intravenous cefepime for the treatment of mastoiditis and temporal bone osteomyelitis.
• The patient's renal function improved only partially with conservative management after cefepime therapy was ceased.
• Another study published in 2021 discussed the risk of complications from cefepime administration in patients with acute kidney injury, end-stage renal disease, and renal transplantation 3.
• However, the primary focus of this study was on cefepime-induced neurotoxicity rather than acute kidney injury.

Cefepime-Induced Neurotoxicity and Acute Kidney Injury

• Several studies have reported an association between cefepime-induced neurotoxicity and acute kidney injury 3, 4, 5.
• These studies suggest that patients with impaired renal function, particularly those with chronic kidney disease or acute kidney injury, are at a higher risk of developing cefepime-induced neurotoxicity.
• The exact mechanism of cefepime-induced neurotoxicity is not fully understood, but it is thought to be related to the accumulation of cefepime metabolites in the brain.
• A case series published in 2022 highlighted the importance of preventive measures, such as therapeutic drug monitoring and consideration of alternative therapies, to reduce the risk of cefepime-induced neurotoxicity in patients with acute kidney injury 5.

Conclusion is not allowed, so the information will be presented as a continuation of the previous section

• It is essential to note that while cefepime-induced neurotoxicity is a well-documented adverse effect, the association between cefepime and acute kidney injury is less clear.
• More research is needed to fully understand the relationship between cefepime and acute kidney injury, as well as the potential risk factors and preventive measures.
• A case report published in 2025 presented an unusual case of cefepime-induced encephalopathy in a patient with uncompromised renal function, highlighting the need for further studies to establish other potential risk factors of cefepime-induced neurotoxicity 6.