Evaluation of Bartter-like Syndrome Associated with Aminoglycoside Micronomocin Sulfate Administration During Acute Pyelonephritis Treatment / 대한신장학회잡지

ABSTRACT

The aminoglycoside antibiotics is widely used in the treatment of infectious caused by gram-negative bacteria and for synergistic effect with(beta-lactam antibiotics. However, its therapeutic usefulness is limited by this potential nephrotoxicity and by disturbance of electrolyte homeostasis resulting in hypomagnesemia, hypokalemia, hypocalcemia such as Bartter-like syndrome. Many case repots have been reported on development of Bartter-like syndrome after aminoglycosides administration. But these reports had the many differences of such as types of aminoglycosides, age of patients, duration and total dose of treatment, combined antibiotics and baseline diseases. Therefore, the purpose of this study is to assess the effects of micronomocin sulfate on magnesium, calcium and potassium status of patients in acute pyelonephritis. Twenty one patients in acute pyelonephritis(18 female/3 male, ages 20-75) was treated with single or combined antibiotics. Eleven of twenty one patients as study group were treated with both micronomicin sulfate(aminoglycoside, 4mg/kg/day, during 5-8days) and flomoxef sodium (3rd cephalosporine, 2g/day, during 5-8days), and ten of twenty one patients as control group were treated only with flomoxef sodium(3rd cephalosporine. 2g/day. during 5-8days). Renal values, plasma and urinary electrolytes were measured before and at the end of IV antibiotic therapy. After micronomicin sulfate administrated for 6.4+/-1.5days, serum Mg, Ca, K, FEMg (fractional excretion of Mg), TTKG(transtubular K concentration gradient) and FECa(fractional excretion of Ca) did not significantly change(p>0.05). Therefore, those results suggest that micromonicin sulfate therapy within dose of 240mg/day(4mg/kg/day) for 6.4+/-1.5days may not cause disturbance of electrolyte homeostasis such as Bartter-like syndrome in acute pyelonephritis. Howerever, electrolyte disturbance is an important complication when aminoglycosides is given in larges doses over extended periods. Therefore, monitoring of blood concentration and urinary losses of electrolyte should be carried out along with careful observation of Bartter-like syndrome.