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Aminoglycoside nephrotoxicity in obstructive jaundice.

T K Desai1, T K Tsang

  • 1Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois.

The American Journal of Medicine
|July 1, 1988
PubMed
Summary

High bilirubin levels in patients with biliary obstruction significantly increase the risk of aminoglycoside nephrotoxicity. Avoid aminoglycosides in these high-risk patients to prevent kidney injury.

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Area of Science:

  • Nephrology
  • Hepatology
  • Pharmacology

Background:

  • Liver disease is a known risk factor for aminoglycoside nephrotoxicity.
  • Specific features of liver disease predisposing to aminoglycoside-induced renal injury require identification.

Purpose of the Study:

  • To identify specific features of liver disease that predispose to aminoglycoside-induced renal injury.

Main Methods:

  • Retrospective review of 42 patients with biliary obstruction and/or cholangitis who received aminoglycosides.
  • Comparison of patient characteristics and laboratory values between those who developed nephrotoxicity and those who did not.

Main Results:

  • Elevated pre-treatment serum bilirubin levels were significantly higher in patients who developed aminoglycoside nephrotoxicity (12.2 mg/dl vs. 3.4 mg/dl).
  • Nephrotoxicity occurred in 47% of patients with bilirubin > 5.0 mg/dl versus 4% with bilirubin < 5.0 mg/dl (p<0.01).
  • Pre-treatment bilirubin levels correlated with changes in creatinine during aminoglycoside therapy (r=0.66, p<0.01).

Conclusions:

  • Aminoglycoside nephrotoxicity risk is significantly elevated in patients with biliary obstruction and high serum bilirubin levels.
  • Avoid aminoglycoside use in patients with biliary obstruction and elevated bilirubin to mitigate renal injury risk.

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