Clinical and pathophysiologic aspects of aminoglycoside nephrotoxicity

Aminoglycoside antibiotics continue to be a mainstay of therapy in the clinical management of gram negative infections, but a major factor in the clinical use of aminoglycosides is their nephrotoxicity. With gram negative organisms accounting for the majority of hospital acquired infections, the occurrence of aminoglycoside induced acute renal failure has become commonplace. Presently at least 10% of all cases of acute renal failure can be attributed to these antibiotics. This article will cover the renal handling of the aminoglycosides, the pathogenetic mechanisms of nephrotoxicity, and the clinical aspects of aminoglycoside induced acute renal failure with particular emphasis on recent data which have increased our understanding of the interaction of aminoglycosides with the renal tubular cell and the effects of this interaction on cellular function and integrity.