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Aminoglycoside-induced reversible tubular dysfunction.

George Alexandridis¹, Evagelos Liberopoulos, Moses Elisaf

¹Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece.

|February 7, 2003

Summary

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Aminoglycoside antibiotics can cause kidney damage. This study highlights two cases of reversible tubular damage, including Fanconi-like syndrome and hypokalemic metabolic alkalosis, despite normal renal function.

Area of Science:

Nephrology
Pharmacology
Toxicology

Background:

Aminoglycosides are potent antibiotics frequently associated with nephrotoxicity.
Nonoliguric renal insufficiency is a recognized adverse effect, often reversible upon drug cessation.
However, subclinical tubular damage can occur without overt changes in renal function.

Observation:

This report details two cases of reversible kidney tubular damage resulting from prolonged aminoglycoside use.
Case 1: A patient presented with a Fanconi-like syndrome, indicating proximal tubular dysfunction.
Case 2: Another patient developed hypokalemic metabolic alkalosis with associated hypomagnesemia, also linked to tubular dysfunction.

Findings:

These cases demonstrate that prolonged aminoglycoside administration can induce specific, reversible tubular defects.

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The observed syndromes (Fanconi-like, hypokalemic metabolic alkalosis with hypomagnesemia) represent distinct patterns of proximal tubular injury.

These findings underscore the potential for subtle, yet significant, nephrotoxicity even when standard renal function tests remain normal.

Implications:

Clinicians should be vigilant for subclinical tubular dysfunction in patients on long-term aminoglycosides.
Early recognition of these specific syndromes may allow for timely intervention and potentially prevent irreversible kidney damage.
Further research is warranted to elucidate the mechanisms of aminoglycoside-induced tubular damage and identify at-risk patients.