Renal Complications Associated with the Use of Dermal Fillers: A Systematic Review
Cosmetic filler injection is ranked as the second most common minimally invasive cosmetic procedure. Its rising popularity may also be accompanied by an increased likelihood of adverse effects, such as allergic, inflammatory, infectious, and functional complications. Among these, kidney-related complications remain unexplored. This study aims to systematically review the literature to identify and summarize the cases of patients who developed kidney disease after cosmetic injections.
Methods/Technique
:The study protocol followed the PRISMA guidelines. Multiple online databases were used to identify articles published until 2024. Eligible studies included cases of patients who developed any type of kidney-related complication after cosmetic filler injections. A two-stage screening process was conducted for study selection; each record was reviewed by two independent investigators, and another independent investigator resolved the conflicts. Data extraction focused primarily on kidney complications and secondary information, which study characteristics, demographics, filler descriptions, laboratory values, treatments, and outcomes.
Results/Complications
:Twenty-two articles were included, published between 1984 and 2022. The majority of the studies from the United States (63.64%, n=14). Twenty-nine patients were identified, from 18 case reports and 4 case series. The mean age of individuals was 46.89 years (SD 15.15), with a predominance of female (89.65%, n=26) and 34.4% (n=10) were transgender (male to female). The most frequently injected anatomical site was the buttocks (72.41%, n=21). The three most identified fillers included silicone (44.83%, n=13), methacrylate (31.03%, n=9), and oil (13.79%, n=4). Notably, the status of the practitioner who administered the injections was unknown or unlicensed in 96.55% (n=28) of cases. The median time from first injection to the onset of kidney complications was five years (range 3 hours – 20 years). The most common reported kidney-related complication was chronic kidney disease, affecting 55.17% (n=16) of patients, and renal biopsies were conducted in 32.14% (n=9) of cases. At diagnosis, the median laboratory values were creatinine of 2.45 mg/dL (range 1.32-11), parathyroid hormone of 7 pg/mL (range 1.27-140), 25-hydroxy vitamin D of 16.55 ng/mL (range 7-71), 1,25-hydroxy vitamin D of 85 pg/mL (range 34-550), and a mean total calcium level of 13.57 mg/dL (SD 1.36). Most patients received treatment through hydration (68.97%, n=20) and steroids (68.97%, n=20), while surgery was performed in 20.69% (n=6) of cases. After the initial episode of a renal complication, 37.93% (n=11) patients achieved remission, 20.69% (n=6) patients developed chronic kidney disease, and 11.11% (n=3) patients died.
Conclusion
:This systematic review described 29 patients who developed renal complications after injections of silicone, methacrylate, and oil. The alarming prevalence of unlicensed or unknown practitioners performing these procedures increases the risk of severe outcomes, including kidney complications. This underscores the need for stringent regulations and education to ensure that cosmetic interventions are performed by qualified professionals. Prioritizing patient safety is essential to mitigate risks and protect individuals seeking these procedures.