Vancomycin renal transport

Pharmacokinetics of vancomycin Renal transport of vancomycin Epidemiology of vancomycin nephrotoxicity Risk factors for nephrotoxicity Therapeutic drug monitoring of vancomycin Prevention of vancomycin nephrotoxicity Alternative gram positive antibiotics References ... 

Despite the known renal disposition and nephrotoxicity of vancomycin, elucidation of its renal transport pathway remains incompletely defined. Early research by Sokol in rabbits demonstrated that vancomycin enters the proximal tubule cell across the basal lateral membrane via the organic acid transport system [186]. In addition, Sokol showed that vancomycin remains sequestered and concentrates inside the PTC. Vancomycin was found to enter the tubular lumen only by the much slower transport pathway of simple diffusion a secretory pathway was not found. This data would suggest that this renal transport pathway is a potential mechanism of vancomycin nephrotoxicity. However, there is not yet data that associates the PTC sequestration of vancomycin with nephrotoxicity or... 

In critically ill patients, co-administration with dobutamine can enhance vancomycin clearance by increasing cardiac output and renal blood flow and by interacting with the renal anion transport system, increasing glomerular filtration rate and renal tubular secretion (121). 

Sokol, PP, Mechanism of vancomycin transport in the kidney studies in rabbit renal brush border and basolateral membrane vesicles. Am J Kidney Dis, 1991,259(3) 1283-87. 

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