Amphotericin B-related nephrotoxicity in low-risk patients
INTRODUCTION: 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. MATERIAL...
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| Format: | Article |
| Language: | English |
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Elsevier
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| Series: | Brazilian Journal of Infectious Diseases |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005&lng=en&tlng=en |
| _version_ | 1818964587735678976 |
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| author | Roberto Herz Berdichevski Luciano Billodre Luis Letícia Crestana Roberto Ceratti Manfro |
| author_facet | Roberto Herz Berdichevski Luciano Billodre Luis Letícia Crestana Roberto Ceratti Manfro |
| author_sort | Roberto Herz Berdichevski |
| collection | DOAJ |
| description | INTRODUCTION: 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. MATERIAL AND 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. CONCLUSION: 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. |
| first_indexed | 2024-12-20T13:03:29Z |
| format | Article |
| id | doaj.art-209f5ffd86324af4b398860800b38c33 |
| institution | Directory Open Access Journal |
| issn | 1678-4391 |
| language | English |
| last_indexed | 2024-12-20T13:03:29Z |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-209f5ffd86324af4b398860800b38c332022-12-21T19:39:51ZengElsevierBrazilian Journal of Infectious Diseases1678-4391102949910.1590/S1413-86702006000200005S1413-86702006000200005Amphotericin B-related nephrotoxicity in low-risk patientsRoberto Herz Berdichevski0Luciano Billodre Luis1Letícia Crestana2Roberto Ceratti Manfro3Universidade Federal do Rio Grande do SulUniversidade Federal do Rio Grande do SulUniversidade Federal do Rio Grande do SulUniversidade Federal do Rio Grande do SulINTRODUCTION: 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. MATERIAL AND 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. CONCLUSION: 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.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005&lng=en&tlng=enAmphotericin Bacute renal failurenephrotoxicitysodium chloride |
| spellingShingle | Roberto Herz Berdichevski Luciano Billodre Luis Letícia Crestana Roberto Ceratti Manfro Amphotericin B-related nephrotoxicity in low-risk patients Brazilian Journal of Infectious Diseases Amphotericin B acute renal failure nephrotoxicity sodium chloride |
| title | Amphotericin B-related nephrotoxicity in low-risk patients |
| title_full | Amphotericin B-related nephrotoxicity in low-risk patients |
| title_fullStr | Amphotericin B-related nephrotoxicity in low-risk patients |
| title_full_unstemmed | Amphotericin B-related nephrotoxicity in low-risk patients |
| title_short | Amphotericin B-related nephrotoxicity in low-risk patients |
| title_sort | amphotericin b related nephrotoxicity in low risk patients |
| topic | Amphotericin B acute renal failure nephrotoxicity sodium chloride |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005&lng=en&tlng=en |
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