Amphotericin B-related nephrotoxicity in low-risk patients

Detalhes bibliográficos
Autor(a) principal: Berdichevski,Roberto Herz
Data de Publicação: 2006
Outros Autores: Luis,Luciano Billodre, Crestana,Letícia, Manfro,Roberto Ceratti
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Brazilian Journal of Infectious Diseases
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005
Resumo: 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.
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spelling Amphotericin B-related nephrotoxicity in low-risk patientsAmphotericin Bacute renal failurenephrotoxicitysodium chlorideINTRODUCTION: 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.Brazilian Society of Infectious Diseases2006-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005Brazilian Journal of Infectious Diseases v.10 n.2 2006reponame:Brazilian Journal of Infectious Diseasesinstname:Brazilian Society of Infectious Diseases (BSID)instacron:BSID10.1590/S1413-86702006000200005info:eu-repo/semantics/openAccessBerdichevski,Roberto HerzLuis,Luciano BillodreCrestana,LetíciaManfro,Roberto Cerattieng2006-07-21T00:00:00Zoai:scielo:S1413-86702006000200005Revistahttps://www.bjid.org.br/https://old.scielo.br/oai/scielo-oai.phpbjid@bjid.org.br||lgoldani@ufrgs.br1678-43911413-8670opendoar:2006-07-21T00:00Brazilian Journal of Infectious Diseases - Brazilian Society of Infectious Diseases (BSID)false
dc.title.none.fl_str_mv Amphotericin B-related nephrotoxicity in low-risk patients
title Amphotericin B-related nephrotoxicity in low-risk patients
spellingShingle Amphotericin B-related nephrotoxicity in low-risk patients
Berdichevski,Roberto Herz
Amphotericin B
acute renal failure
nephrotoxicity
sodium chloride
title_short 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_sort Amphotericin B-related nephrotoxicity in low-risk patients
author Berdichevski,Roberto Herz
author_facet Berdichevski,Roberto Herz
Luis,Luciano Billodre
Crestana,Letícia
Manfro,Roberto Ceratti
author_role author
author2 Luis,Luciano Billodre
Crestana,Letícia
Manfro,Roberto Ceratti
author2_role author
author
author
dc.contributor.author.fl_str_mv Berdichevski,Roberto Herz
Luis,Luciano Billodre
Crestana,Letícia
Manfro,Roberto Ceratti
dc.subject.por.fl_str_mv Amphotericin B
acute renal failure
nephrotoxicity
sodium chloride
topic Amphotericin B
acute renal failure
nephrotoxicity
sodium chloride
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.
publishDate 2006
dc.date.none.fl_str_mv 2006-04-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702006000200005
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/S1413-86702006000200005
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Brazilian Society of Infectious Diseases
publisher.none.fl_str_mv Brazilian Society of Infectious Diseases
dc.source.none.fl_str_mv Brazilian Journal of Infectious Diseases v.10 n.2 2006
reponame:Brazilian Journal of Infectious Diseases
instname:Brazilian Society of Infectious Diseases (BSID)
instacron:BSID
instname_str Brazilian Society of Infectious Diseases (BSID)
instacron_str BSID
institution BSID
reponame_str Brazilian Journal of Infectious Diseases
collection Brazilian Journal of Infectious Diseases
repository.name.fl_str_mv Brazilian Journal of Infectious Diseases - Brazilian Society of Infectious Diseases (BSID)
repository.mail.fl_str_mv bjid@bjid.org.br||lgoldani@ufrgs.br
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