Aminoglycoside-induced reversible tubular dysfunction

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George Alexandridis1, Evagelos Liberopoulos, Moses Elisaf

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

Pharmacology
|February 7, 2003
PubMed

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.

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