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Updated: Sep 11, 2025

Kidney Regeneration in Adult Zebrafish by Gentamicin Induced Injury

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Published on: August 3, 2015

Cystatin C for gentamicin dosing - a case study.

Tomáš Šálek^1,2, Josef Klhůfek³, Martin Vodička³

¹Department of Clinical Biochemistry and Pharmacology, Tomas Bata Hospital in Zlín, Zlín, Czech Republic.

Biochemia Medica

|August 18, 2025

Summary

An elderly patient experienced dangerously high gentamicin levels due to inaccurate kidney function estimates. This case highlights the risk of falsely high estimated glomerular filtration rate (eGFR) in older adults, impacting drug dosing.

Keywords:

creatinine cystatin C drug overdose gentamicins glomerular filtration rate

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Area of Science:

Nephrology
Clinical Pharmacology
Geriatrics

Background:

Gentamicin is an antibiotic requiring careful dosing based on kidney function.
Accurate estimation of glomerular filtration rate (eGFR) is crucial for preventing aminoglycoside toxicity.

Observation:

An 83-year-old male patient developed supratherapeutic serum gentamicin concentrations (2.5 mg/L).
The patient presented with heart failure and pneumonia, receiving 240 mg of gentamicin daily.
Concurrent measurements showed eGFRcrea of 62 mL/min/1.73m² and eGFRcys of 25 mL/min/1.73m².

Findings:

A significant discrepancy (148%) was observed between eGFRcrea and eGFRcys.
Falsely elevated eGFRcrea in this elderly patient led to underestimation of gentamicin accumulation risk.
The standard gentamicin dose resulted in supratherapeutic levels due to inaccurate renal function assessment.

Implications:

This case underscores the potential for creatinine-based eGFR (eGFRcrea) to overestimate renal function in elderly individuals.
Relying solely on eGFRcrea can lead to suboptimal antibiotic dosing and adverse drug events.
Cystatin C-based eGFR (eGFRcys) may offer a more reliable assessment of kidney function in specific patient populations, guiding safer gentamicin therapy.