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[Nephrotoxicity caused by amphotericin B]

F Mota Hernández, R Gastelbondo, P N Saracho

    Boletin Medico Del Hospital Infantil De Mexico
    |November 1, 1981
    PubMed
    Summary
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    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.

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  • 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.