Amphotericin B-related nephrotoxicity in low-risk patients.
BACKGROUND
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.


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.


CONCLUSIONS
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.
Berdichevski
Roberto Herz
RH
Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Brazil. roberto.herz@terra.com.br
Luis
Luciano Billodre
LB
Crestana
Letícia
L
Manfro
Roberto Ceratti
RC
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D009181:Mycoses / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage*
D000935:Antifungal Agents; D012965:Sodium Chloride; D000666:Amphotericin B; D003404:Creatinine