Acute renal failure pentamidine

Sensakovic JW, Suarez M, Perez G, Johnson ES, Smith LG. Pentamidine treatment of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. Association with acute renal failure and myoglobinuria. Archives of internal medicine. 

Miller RF, Delany S, Semple SJ. Acute renal failure after nebulised pentamidine. Lancet. 1989 Jun 3 1(8649) 1271-2. 

Prior to the AIDS epidemic, the incidence of acute renal failure associated with intravenous pentamidine administration for the treatment of PCP was between 19 to 23% [123,125]. During the 1980 s the number of reported cases increased (Table 1). The average incidence of nephrotoxicity, the most frequent systemic adverse effect, was 41%, ranging from 20 to 94% as... 

Four cases of reversible acute renal failure in patient with AIDS who received both intravenous pentamidine (for PCP) and amphotericin B (for systemic mycoses) have been recently reported [139]. Of note, nephrotoxicity did not develop in three AIDS patients treated with both TMP-SMZ and amphotericin B or in two patients who concomitantly received inhaled pentamidine and amphotericin B [139]. Reports of renal damage in patients receiving parenteral pentamidine for the treatment of non-HIV diseases continue. Reversible acute renal failure and nephrotic syndrome were documented in a young child given pentamidine mesylate and an antimonial salt for the treatment of visceral leishmaniasis [140]. In Africa (Kenya) patients with visceral leishmaniasis have developed renal toxicity during prolonged treatment (1 to 10 months) with pentamidine [141]. 

There is some evidence to suggest that acute renal failure may develop in patients taking amphotericin B if they are also given parenteral pentamidine. 

Antoniskis D, Larsen RA. Acute, rapidly progressive renal failure with simultaneous use of amphotericin B and pentamidine. Antimicrobial agents and chemotherapy. 1990 Mar 34(3) 470-2. 

A retrospective study between 1985 and 1988 identified 101 patients with AIDS who had been given amphotericin B for various systemic mycoses. The patients were given amphotericin 0.6 to 0.8 mg/kg daily for 7 to 10 days, then a dose three times a week for about 9 weeks. Nine patients were concurrently treated for Pneumocystis carinii pneumonia, and of these the 4 who had been given pentamidine parenterally developed acute and rapid reversible renal failure. In all 4 cases, renal function returned to normal when the drugs were withdrawn. No renal failure was seen in 2 others given pentamidine by inhalation or 3 given intravenous co-trimox-azole. ... 

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