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Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin
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Pathophysiology, risk factors and clinical management for polymyxin-associated acute kidney injury

Simiao Zhao1, Guangyan Mu1, Xiao Liu1

  • 1Department of Pharmacy, Peking University First Hospital, Beijing, China.

The Journal of Antimicrobial Chemotherapy
|April 11, 2026
PubMed

Insights

Polymyxins are crucial for treating resistant infections but can cause kidney injury. Strategies like monitoring drug levels and avoiding other kidney-harming drugs can reduce this risk.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Polymyxins are vital last-resort antibiotics for multidrug-resistant Gram-negative infections.
  • Polymyxin-associated acute kidney injury (PA-AKI) significantly limits their clinical use, especially in critically ill patients.

Purpose of the Study:

  • To review the pathophysiology, risk factors, and clinical management of PA-AKI.
  • To provide updated perspectives on PA-AKI prevention and treatment strategies.

Main Methods:

  • Literature review focusing on PA-AKI pathophysiology, risk factors, and management.
  • Analysis of current evidence regarding prevention and treatment interventions.
  • Discussion of emerging biomarkers and future research directions.

Main Results:

  • Reducing exposure to nephrotoxic agents and consistent monitoring of renal function and drug levels are key to mitigating PA-AKI.
  • Several biomarkers show potential for early PA-AKI prediction but require further clinical validation.
  • Incorporating real-world evidence into guidelines and developing less nephrotoxic polymyxins are crucial.

Conclusions:

  • Effective management of PA-AKI involves a multifaceted approach including risk factor reduction and vigilant monitoring.
  • Further research is needed to validate predictive biomarkers and develop safer polymyxin alternatives.
  • Clinical practice guidelines should integrate real-world data to optimize polymyxin therapy and minimize kidney injury.

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