Amphotericin B-related nephrotoxicity in low-risk patients

INTRODUCTION: Amphotericin B (AmphoB) is the drug of choice for treatment of severe fungal illnesses; however, it is very nephrotoxic. Modified (less toxic) amphotericins are very expensive. In low-risk patients, saline loading would be enough to prevent significant loss of renal function. MATERIAL AND METHODS: Patients with normal renal function and within the first 24 hours of treatment with AmphoB were prospectively enrolled in the study. Patients in intensive care units or who were using vasoactive drugs were excluded. Saline loads were infused before and after the AmphoB treatment. Blood and urine analyses were made at the beginning and at the end of the treatment. Serum creatinine was repeated 30 days after the end of the AmphoB treatment. RESULTS: The mean increase in serum creatinine in the 48 patients was 0.3 (0.18-0.41) mg/dL, due to a mean decrease of 25 (12.8-36.9) mL/min of creatinine clearance (CrCl). Acute renal failure, defined as an increase of more than 50 percent of the baseline creatinine, occurred in 15 patients (31 percent). Patients that were on antibiotics, in post-chemotherapy status or those submitted to bone marrow transplantation had the highest risk. Mean serum creatinine and the CrCl levels were no different from baseline values after 30 days. CONCLUSION: In low-risk patients, the use of AmphoB with prophylactic sodium chloride loading was associated with a small and reversible decrease in renal function. Due to its high cost the use of more expensive therapies for this type of patient does not seem to be justified.

Nefropatia isquêmica / Ischemic nephropathy

O presente artigo aborda a nefropatia isquêmica – entidade cada vez mais reconhecida comocausa importante de insuficiência renal crônica, principalmente em populações com alto riscocardiovascular – e atualiza conhecimentos sobre epidemiologia, etiologia, fisiopatologia, manifestaçõesclínicas e tratamento da referida entidade. Uma abordagem sistemática do assunto é proposta.

The present article is a review about ischemic nephropathy, a clinical entity that has gainedrecognition as a major cause of chronic renal failure, mainly in populations at higher cardiovascularrisk. The literature about the epidemiology, etiology, pathophysiology, clinical manifestations andtreatment aspects of this disease are revised and a systematic approach to it is proposed.

Biópsia renal percutânea na prática clínica: técnicas, indicaçöes, contra-indicaçöes e complicaçöes / Percutaneous renal biopsy

O presente artigo traz uma revisÝo sobre biópsia renal percutânea, enfocando aspectos da técnica, indicaçSes, contraindicaçSes e complicaçSes do procedimento