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Amphotericin B-related nephrotoxicity in low-risk patients
Berdichevski, Roberto Herz; Luis, Luciano Billodre; Crestana, Letícia; Manfro, Roberto Ceratti.
  • Berdichevski, Roberto Herz; Hospital de Clínicas de Porto Alegre. Division of Nephrology. Porto Alegre. BR
  • Luis, Luciano Billodre; Federal University of Rio Grande do Sul. School of Medicine. Department of Internal Medicine. Porto Alegre. BR
  • Crestana, Letícia; Federal University of Rio Grande do Sul. School of Medicine. Department of Internal Medicine. Porto Alegre. BR
  • Manfro, Roberto Ceratti; Federal University of Rio Grande do Sul. School of Medicine. Department of Internal Medicine. Porto Alegre. BR
Braz. j. infect. dis ; 10(2): 94-99, Apr. 2006. tab
Artigo em Inglês | LILACS | ID: lil-431980
RESUMO

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.
Assuntos
Texto completo: DisponíveL Índice: LILACS (Américas) Assunto principal: Cloreto de Sódio / Anfotericina B / Injúria Renal Aguda / Antifúngicos Tipo de estudo: Estudo de etiologia / Estudo observacional / Fatores de risco Limite: Adulto / Feminino / Humanos / Masculino Idioma: Inglês Revista: Braz. j. infect. dis Assunto da revista: Doenças Transmissíveis Ano de publicação: 2006 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: Federal University of Rio Grande do Sul/BR / Hospital de Clínicas de Porto Alegre/BR

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Texto completo: DisponíveL Índice: LILACS (Américas) Assunto principal: Cloreto de Sódio / Anfotericina B / Injúria Renal Aguda / Antifúngicos Tipo de estudo: Estudo de etiologia / Estudo observacional / Fatores de risco Limite: Adulto / Feminino / Humanos / Masculino Idioma: Inglês Revista: Braz. j. infect. dis Assunto da revista: Doenças Transmissíveis Ano de publicação: 2006 Tipo de documento: Artigo País de afiliação: Brasil Instituição/País de afiliação: Federal University of Rio Grande do Sul/BR / Hospital de Clínicas de Porto Alegre/BR