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Acute, rapidly progressive renal failure with simultaneous use of amphotericin B and pentamidine
1Los Angeles County-University of Southern California Medical Center 90033.
Abstract:
We report four cases of acute reversible renal failure in patients with acquired immune deficiency syndrome who received both amphotericin B (for systemic mycoses) and pentamidine isethionate (for Pneumocystis carinii pneumonia). The concurrent use of amphotericin B with either inhaled pentamidine or trimethoprim-sulfamethoxazole did not cause significant renal impairment.
Insights
Concurrent use of amphotericin B and pentamidine isethionate may cause acute kidney injury in patients with acquired immune deficiency syndrome. However, amphotericin B with inhaled pentamidine or trimethoprim-sulfamethoxazole did not significantly impair renal function.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Acquired immune deficiency syndrome (AIDS) patients often require treatment for opportunistic infections like systemic mycoses and Pneumocystis carinii pneumonia.
- Amphotericin B is a critical antifungal agent, while pentamidine isethionate is used for Pneumocystis pneumonia.
- Renal toxicity is a known concern with certain antimicrobial agents.
Observation:
- Four cases of acute reversible renal failure were observed in patients with AIDS.
- These patients were concurrently receiving amphotericin B and pentamidine isethionate.
- No significant renal impairment was noted when amphotericin B was used with inhaled pentamidine or trimethoprim-sulfamethoxazole.
Findings:
- The combination of intravenous amphotericin B and pentamidine isethionate was associated with acute reversible renal failure in AIDS patients.
- This specific drug combination appears to pose a higher risk for nephrotoxicity compared to other regimens.
- Renal function recovered after discontinuation of the offending agents.
Implications:
- Clinicians should exercise caution when prescribing concurrent amphotericin B and pentamidine isethionate to AIDS patients.
- Monitoring renal function is crucial in patients receiving this drug combination.
- Alternative treatment strategies or careful monitoring may be necessary to mitigate nephrotoxicity risks.