Aminoglycoside nephrotoxicity in obstructive jaundice.
OBJECTIVE
Although it is known that liver disease predisposes to aminoglycoside nephrotoxicity, specific features of such disease that may predispose to aminoglycoside-induced renal injury have not been identified. We sought to identify such features.


METHODS
We undertook a retrospective review of the charts of 42 consecutive patients with biliary obstruction and/or cholangitis who had received more than three doses of an aminoglycoside.


RESULTS
Comparison of patients in whom aminoglycoside nephrotoxicity did and did not develop revealed no differences in age, race, sex, dose, and duration of aminoglycoside therapy; mean peak and trough aminoglycoside levels; initial pre-treatment levels of serum creatinine, aspartate transaminase, alkaline phosphatase, or albumin; or prothrombin time. The initial pre-treatment serum bilirubin level was higher in the patients in whom aminoglycoside nephrotoxicity developed (12.2 +/- 8.8 mg/dl versus 3.4 +/- 3.2 mg/dl, p less than 0.01). Aminoglycoside nephrotoxicity occurred in eight patients (19 percent): in seven of 15 patients (47 percent) with an initial bilirubin value greater than 5.0 mg/dl, but in only one of 27 patients (4 percent) with an initial bilirubin value below 5.0 mg/dl (p less than 0.01). The pre-treatment bilirubin level correlated with the change in creatinine during aminoglycoside therapy (n = 42, r = 0.66, p less than 0.01).


CONCLUSIONS
Aminoglycosides should probably be avoided in patients with biliary obstruction and a high serum bilirubin level.
Desai
T K
TK
Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
Tsang
T K
TK
D000583:Amikacin / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002761:Cholangitis / Q000188:drug therapy*; D002779:Cholestasis / Q000188:drug therapy*; D005260:Female; D005839:Gentamicins / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014031:Tobramycin / Q000009:adverse effects
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000583:Amikacin; D014031:Tobramycin