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Aminoglycoside nephrotoxicity following single-dose cystoscopy prophylaxis
1Department of Pharmacy, Sinai Samaritan Medical Center, Milwaukee, WI 53233.
The Annals of Pharmacotherapy
|February 1, 1994
Summary
A single dose of gentamicin caused acute tubular necrosis in an elderly patient, highlighting potential nephrotoxicity risks even with short-term exposure.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Aminoglycosides, like gentamicin, are commonly used antibiotics.
- Nephrotoxicity is a known, but typically dose-dependent, adverse effect of aminoglycosides.
- Current understanding suggests prolonged or high-dose exposure is required for significant kidney injury.
Observation:
- An 82-year-old male with stable renal insufficiency received a single prophylactic dose of gentamicin (1.6 mg/kg) before a cystoscopy.
- Within 48 hours of administration, the patient experienced a significant decline in renal function.
- The patient presented with nonoliguric acute tubular necrosis.
Findings:
- A nephrology consultation ruled out other potential causes of acute kidney injury.
- The observed acute tubular necrosis was directly attributed to the single dose of gentamicin.
- This case suggests a potential for acute tubular necrosis following even a single, standard prophylactic dose of gentamicin.
Implications:
- This case challenges the established dose-response relationship for gentamicin-induced nephrotoxicity.
- It highlights the need for careful consideration of gentamicin use, even for short durations, in elderly patients or those with pre-existing renal compromise.
- Further investigation into the mechanisms of aminoglycoside nephrotoxicity may be warranted to explain such acute presentations.