Biopsy-proven anuric acute tubular necrosis associated with vancomycin and one dose of aminoside

A 71-year-old woman with a history of hyperten-sion and restrictive chronic respiratory failure wasadmitted to our intensive care unit (ICU) for dyspnoea.She had been on levofloxacin for 3 weeks forpneumonia, and had purulent expectoration, fever(38.5 C) and pulmonary crepitations, but no signs ofhaemodynamic failure or hypersensitivity. Antibio-therapy was initiated empirically, with piperacillin,tazobactamandamikacin(10mg/kgonce),andafter48hours also vancomycin (2g/day), based on a bloodculture positive for meticillin resistant Staphylococcusaureus. After 3 days, her laboratory tests showed:serum creatinine, 396mmol/l (75mmol/l at admission);no hypereosinophilia, vancomycin residual bloodlevel 47.8mg/l (normal 20 to 30mg/l). A renal echog-raphy ruled out an obstructive uropathy. Urinetests suggested an organic acute renal failure (ARF)(natriuresis/kaliuresis