Nephrotoxicity of amphotericin

Bnrges JL, Birchah R. Nephrotoxicity of amphotericin B, with emphasis on changes in tnbnlar fnnction. Am J Med 1972 53(l) 77-84. 

Butler WT, Bennett JE, Ailing DW, et al. Nephrotoxicity of amphotericin B early and late effects in 81 patients. Ann Intern Med 1964 61 175-87. 

Echevarria J, Seas C, Cruz M, et al. Oral rehydration solution to prevent nephrotoxicity of amphotericin B. Am JTrop Med Hyg 2006 75 1108-1 2. 

LeBrun, M., L. Grenier, M. G. Bergeron, L. Tibault, G. Labrecque, and D. Beauchamp. 1999. Effects of fasting on temporal variation in the nephrotoxicity of amphotericin B in rats. Antimicrobial Agents and Chemotherapy 43 520-524. 

Feeley J, Heidemann H, Gerkens J, Roberts LJ, Branch RA. Sodium depletion enhances nephrotoxicity of amphotericin B. Lancet (1981) i, 1422-3. 

The basis for the nephrotoxicity of amphotericin B has been studied, using turtle bladder as a model system. In one study, exposure of turtle urinary bladder to amphotericin B resulted in changes in the electrophysiological properties of the bladder and in morphological changes in the mucosal cells. The results indicate that the primary effect is on luminal plasma membranes. In another study, the impairment of urinary acidification was investigated, using turtle bladder that had been exposed to amphotericin B. The results indicate that this defect is attributable to increased passive permeability of the luminal membrane and not to failure of active transport. 

Amphotericin B-induced ARF occurs in as many as 40% to 65% of patients treated with the conventional desoxycholate formulation.30 Nephrotoxicity is due to renal arterial vasoconstriction and distal renal tubule cell damage. Risk factors include high doses, treatment for at least 7 days, preexisting kidney dysfunction, and concomitant use of other nephrotoxic drugs.31 Three lipid-based formulations of amphotericin B have been developed in an attempt to decrease the incidence of ARF amphotericin B lipid complex, amphotericin colloidal dispersion, and liposomal amphotericin B. The range of... 

The severity of aminoglycoside nephrotoxicity is additive with that of vancomycin, polymixin, gallium, furosemide, enflurane, cisplatin, and cephalosporins. Aminoglycoside nephrotoxicity is synergistic with that of amphotericin B and cyclosporine. 

Nephrotoxicity is the most common and the most serious long-term toxicity of amphotericin B administration. This drug reduces glomerular and renal tubular blood flow through a vasoconstrictive effect on afferent renal arterioles, which can lead to destruction of renal tubular cells and disruption of the tubular basement... 

L A. Nephrotoxicity is the most common and most serious toxicity associated with amphotericin B administration. This is manifested by azotemia (elevated serum blood urea nitrogen and creatinine), and by renal tubular acidosis, which results in the wasting of potassium and magnesium in the urine (leading to hypokalemia and hypomagnesemia, requiring oral or intravenous replacement therapy). Normochromic normocytic anemia is also seen with long-term amphotericin B administration. Elevation of hver enzymes is not associated with the use of amphotericin B. 

Gallium Nitrate (Ganite) [Hormone] Uses T Ca2+ of malignancy bladder CA Action X- bone resorption of Ca2+ Dose T Ca2+ 200 mg/m2/d x 5 d CA 350 mg/m2 cont inf X 5 d to 700 mg/m2 rapid IV inf q2wk in antineoplastic settings (per protocols) Caution [C, ] Do not give w/ live or rotavirus vaccine Contra SCr >2.5 mg/dL Disp Inj SE Renal insuff, X- Ca2+, hypophosphatemia, X- bicarb, <1% acute optic neuritis Interactions T Risks of nephrotox W/ amphotericin B,... 

The irreversible form of amphotericin nephrotoxicity usually occurs in the setting of prolonged administration (> 4 g cumulative dose). Renal toxicity commonly presents with renal tubular acidosis and severe potassium and magnesium wasting. There is some evidence that the prerenal component can be attenuated with sodium loading, and it is common practice to administer normal saline infusions with the daily doses of amphotericin B. 

Amphotericin B (AmB) is a polyene macrolide used in the treatment of systemic fungal infections. The clinical use of amphotericin, however, is limited by its dose-dependent nephrotoxicity. A number of studies have shown that AmB is... 

Aspirin, paracetamol, and hydrocortisone are used to control febrile reactions of amphotericin. Patients with a history of adverse effects with amphotericin should be prophylactically treated with antipyretics and hydrocortisone. Antiemetics and pethidine also are used for the treatment of adverse effects of amphotericin. With sodium supplements and hydration therapy, damage to the kidney can be reduced. If conventional amphotericin is not well tolerated by the patient, colloidal carriers can be used as alternative options. Administration of amphotericin with a nephrotoxic drug, such as cyclosporin, may further increase toxicity. Diuretics and anticancer drugs should be avoided with amphotericin. 

One compound that has been associated with distal tubular injury is amphotericin B, a polyene antifungal agent used in the treatment of systemic mycoses caused by opportunistic fungi. Clinical utility of amphotericin B is limited by its nephrotoxicity, characterized functionally by polyuria resistant to antidiuretic hormone administration, hyposthenuria, hypokalemia, and mild renal tubular acidosis. 

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