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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.
Abstract:
Nonoliguric renal insufficiency is a well-known nephrotoxic consequence of aminoglycosides, although reversible tubular damage in the absence of any change in the renal function has been occasionally found. Reported herein are 2 representative cases of a reversible tubular damage due to prolonged aminoglycoside administration: a patient with a Fanconi-like syndrome of proximal tubular dysfunction and a patient with a syndrome of hypokalemic metabolic alkalosis associated with hypomagnesemia.
Insights
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.
- 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.