[Voriconazole compromises renal function in an elderly CDK patient with Candida albicans infection].
There has been a progressive increase in the number of intensive care patients being transferred to nephrology units because of improper dosage of drugs, especially patients with chronic kidney disease (CKD). Voriconazole is a new synthetic triazole derivative with stronger therapeutic activity against fungal infections than fluconazole or itraconazole. Its effectiveness is associated with high nephrotoxicity, affecting patients with CKD in particular. The adverse effects of voriconazole involve several segments of the nephron, particularly the proximal tubule, medullary thick ascending limb, and collecting duct, causing loss of potassium and magnesium and backdiffusion of hydrogen ions. We report the case of an 86-year-old man with moderate CKD who developed acute renal failure as a result of inadequate dosage of voriconazole. He developed oliguria, electrolyte imbalance and fluid overload requiring hemodialysis. Vericonazole withdrawal associated with short daily hemodialysis treatment led to the recovery of diuresis, kidney function, and electrolyte balance. In conclusion, in elderly patients with liver disease and moderate CKD, thorough evaluation is needed before the administration of voriconazole in order to establish the most appropriate dose.
Prima Divisione di Nefrologia, Seconda Università degli Studi, Napoli. pietro.anastasio@unina2.it
Pietro
P
Anastasio
Fabiana
F
Marcarelli
Giancarlo
G
Bilancio
Alessandra Antonia
AA
Mele
Natale Gaspare
NG
De Santo
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000009:adverse effects*; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy*; D002908:Chronic Disease; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D011743:Pyrimidines / Q000009:adverse effects*; D014230:Triazoles / Q000009:adverse effects*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole