Amphotericin B-related nephrotoxicity in low-risk patients

Abstract

Introduction. Amphotericin B (AmphoB) is the drug of choice for treatment of severe fungal illnesses; however, it is very nephrotoxic. Modified (less toxic) amphotericins are very expensive. In low-risk patients, saline loading would be enough to prevent significant loss of renal function. Material and Methods. Patients with normal renal function and within the first 24 hours of treatment with AmphoB were prospectively enrolled in the study. Patients in intensive care units or who were using vasoactive drugs were excluded. Saline loads were infused before and after the AmphoB treatment. Blood and urine analyses were made at the beginning and at the end of the treatment. Serum creatinine was repeated 30 days after the end of the AmphoB treatment. Results. The mean increase in serum creatinine in the 48 patients was 0.3 (0.18-0.41) mg/dL, due to a mean decrease of 25 (12.8-36.9) mL/min of creatinine clearance (CrCl). Acute renal failure, defined as an increase of more than 50% of the baseline creatinine, occurred in 15 patients (31%). Patients that were on antibiotics, in post-chemotherapy status or those submitted to bone marrow transplantation had the highest risk. Mean serum creatinine and the CrCl levels were no different from baseline values after 30 days. Conclusion. In low-risk patients, the use of AmphoB with prophylactic sodium chloride loading was associated with a small and reversible decrease in renal function. Due to its high cost the use of more expensive therapies for this type of patient does not seem to be justified.

Risk Factors for Acute Kidney Injury in Visceral Leishmaniasis (Kala-Azar)

“…In a recent study with 48 patients receiving amphotericin B, AKI (defined as an increase of > 50% in basal creatinine levels) occurred in 31% of cases. 27 Higher incidences of AKI secondary to the use of amphotericin B have been reported, with percentages as high as 80% of patients receiving this drug. 28 In the present study, AKI developed in a high number of patients receiving amphotericin B (82.9%).…”

Clinical presentation and renal evaluation of human visceral leishmaniasis (kala-azar): a retrospective study of 57 patients in Brazil

“…In our study, the patients with serum creatinine higher than 1.3mg/dL were older and needed treatment for longer periods. Amphotericin B is a known nephrotoxin; increases in serum urea and creatinine have been reported to occur in over 80% of patients treated with this drug [17,18]. Amphotericin B was used in 11 patients in the group with Scr≥1.3mg/dL; however, eight of these patients had elevated creatinine before anphotericin B administration.…”

Concentração de cálcio no dialisato e hipercalcemia na DRC

“…The high permeability of the luminal tubular membrane to K + and H + cations is a result of the formation of intramembranous pores after AB is connected to the cholesterol of the membrane, enabling K + loss through urine and plasma K + decrease. 16,18,28,29 The patient had a decrease in renal blood flow, which led to oliguria, elevation of creatinine and decrease of serum potassium during the administration of ATRA and AB. Even though AB therapy causes hyponatremia and hypomagnesemia, sodium and magnesium serum values were within the reference limits from hospital admission to discharge, probably due to hydroelectrolytic therapy.…”