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Gentamicin-associated acute renal failure

N E Gary, L Buzzeo, J Salaki

    Archives of Internal Medicine
    |October 1, 1976
    PubMed
    Summary
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    Gentamicin sulfate can cause acute kidney injury, even when used alone. Elderly patients or those with existing kidney issues require careful monitoring during gentamicin therapy to prevent nephrotoxicity.

    Area of Science:

    • Nephrology
    • Pharmacology
    • Toxicology

    Background:

    • Gentamicin is a widely used antibiotic.
    • Nephrotoxicity is a known side effect of aminoglycosides.
    • Risk factors for gentamicin-induced nephrotoxicity are not fully elucidated.

    Observation:

    • Five adult patients (age >45) developed acute renal failure solely attributed to gentamicin sulfate.
    • Patients received 1.2 to 2.88 gm over 12-18 days.
    • Pre-existing renal abnormalities may increase susceptibility.

    Findings:

    • Renal failure manifested 8-17 days after initiating gentamicin.
    • Key indicators included low creatinine clearance (4-10 ml/min), low urine to plasma creatinine ratio (<20), elevated urinary sodium (16-60 mEq/L), proteinuria, and cylindruria.

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  • Absence of oliguria complicated early recognition of kidney damage.

    • Implications:

    • Gentamicin alone can be nephrotoxic.
    • Particular caution is advised for elderly patients and individuals with pre-existing renal conditions.
    • Enhanced vigilance is necessary to detect gentamicin-induced nephrotoxicity, especially when oliguria is absent.