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[Nephrotoxicity caused by amphotericin B]
Boletin Medico Del Hospital Infantil De Mexico
|November 1, 1981
Summary
This case report details a child with coccidioidomycosis who experienced reversible kidney damage from amphotericin B treatment. Early signs of nephrotoxicity appeared after 1,000 mg, resolving upon drug cessation and potassium bicarbonate.
Area of Science:
- Nephrology
- Mycology
- Pediatric Infectious Diseases
Background:
- Coccidioidomycosis is a fungal infection endemic to certain regions.
- Amphotericin B is a primary antifungal agent used for severe coccidioidomycosis.
- Nephrotoxicity is a known, albeit manageable, side effect of amphotericin B therapy.
Observation:
- A six-year-old child diagnosed with coccidioidomycosis was treated with intravenous amphotericin B.
- Renal function disturbances, including renal failure, were observed during treatment.
- Nephrotoxicity manifested after a cumulative dose of 1,000 mg of amphotericin B.
Findings:
- Early signs included glycosuria, cylindruria, and elevated urinary pH.
- Metabolic acidosis, hypokalemia, and reduced renal concentrating capacity were noted.
- Endogenous creatinine clearance also showed a decrease, indicating impaired kidney function.
Implications:
- Amphotericin B-induced nephrotoxicity can be significant but is often reversible.
- Monitoring renal function is crucial during amphotericin B treatment, especially in pediatric patients.
- Discontinuation of the drug and supportive care, such as potassium bicarbonate administration, can lead to recovery of renal function.