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Trimethoprim, creatinine and creatinine-based equations.

Pierre Delanaye1, Christophe Mariat, Etienne Cavalier

  • 1Department of Nephrology, Dialysis, Hypertension, Transplantation, University of Liège, Liège, Belgium. pierre_delanaye@yahoo.fr

Nephron. Clinical Practice
|August 12, 2011
PubMed
Summary
This summary is machine-generated.

Co-trimoxazole, a common antibiotic, can affect kidney function tests. Trimethoprim falsely lowers estimated GFR by inhibiting creatinine secretion, while sulfamethoxazole may cause actual kidney damage at high doses.

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Area of Science:

  • Pharmacology
  • Nephrology
  • Clinical Medicine

Background:

  • Co-trimoxazole, a combination of trimethoprim and sulfamethoxazole (Sfx), is widely used for urinary tract and Pneumocystis jirovecii infections.
  • Sulfamethoxazole can be nephrotoxic at high doses or with inadequate GFR adjustment.
  • Trimethoprim inhibits tubular creatinine secretion, impacting GFR estimations.

Purpose of the Study:

  • To review the distinct effects of trimethoprim and Sfx on serum creatinine and GFR.
  • To assess the clinical relevance of these effects, particularly in kidney transplant recipients.

Main Methods:

  • Literature review focusing on studies examining trimethoprim and Sfx effects on renal function.
  • Analysis of evidence regarding serum creatinine changes and GFR estimations.
  • Examination of clinical implications, including in kidney transplantation.

Main Results:

  • Trimethoprim causes a reversible increase in serum creatinine independent of GFR changes.
  • This leads to falsely decreased estimated GFR (eGFR) when using creatinine-based equations.
  • Sulfamethoxazole's nephrotoxicity is dose-dependent and linked to GFR.
  • The differential effects are crucial for interpreting renal function in patients on co-trimoxazole.

Conclusions:

  • Trimethoprim's inhibition of creatinine secretion can lead to misinterpretation of kidney function.
  • Careful consideration of co-trimoxazole's components is necessary for accurate GFR assessment, especially in vulnerable populations like kidney transplant patients.
  • Distinguishing between drug-induced creatinine changes and actual nephrotoxicity is vital for appropriate clinical management.