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Amphotericin B nephrotoxicity in children

Ran D Goldman1, Gideon Koren

  • 1Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, Canada.

Journal of Pediatric Hematology/Oncology
|June 26, 2004
PubMed

Insights

Amphotericin B treats severe fungal infections but can harm kidneys, especially in children. Lipid formulations and hydration help prevent this nephrotoxicity.

Area of Science:

  • Nephrology
  • Mycology
  • Pediatric Pharmacology

Background:

  • Amphotericin B is a critical antifungal agent for severe systemic infections.
  • Nephrotoxicity is a significant adverse effect, with limited pediatric data.
  • Understanding pediatric nephrotoxicity is crucial for safe treatment.

Purpose of the Study:

  • To review the mechanisms and risk factors of Amphotericin B-induced nephrotoxicity.
  • To explore preventive strategies for nephrotoxicity in pediatric patients.
  • To highlight current management options for Amphotericin B nephrotoxicity.

Main Methods:

  • Literature review of Amphotericin B nephrotoxicity.
  • Analysis of mechanisms including deoxycholate vehicle, renal hemodynamics, and cellular apoptosis.
  • Identification of risk factors such as cumulative dose, duration, and concomitant nephrotoxic drugs.

Main Results:

  • Nephrotoxicity manifests as reduced GFR, distal tubulopathy, electrolyte wasting, and renal tubular acidosis.
  • Mechanisms involve direct cellular damage, altered renal blood flow, and drug interactions.
  • Risk factors include high cumulative dosage, prolonged treatment, and co-administration with diuretics or cyclosporine.

Conclusions:

  • Lipid formulations (e.g., L-AMB) and volume repletion are key preventive measures.
  • Amiloride may help manage significant potassium loss.
  • Further pediatric studies are needed to optimize Amphotericin B use and minimize renal injury.

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