ABSTRACT
Introduction: Following second wave of COVID 19 infection in India there has been unprecedented spike in mucormycosis cases. Liposomal amphotericin(LAmB) is the drug of choice in most of these cases. Though nephrotoxicity of conventional amphotericin has been well described in literature, there is sparse data on nephrotoxicity following of LAmB use.Herein we describe spectrum of kidney disease and electrolyte abnormalities that arised following LAmB use in patients afflicted with mucormycosis. Method(s): It is a single centre retrospective observational study. Hospitalised patients with mucormycosis who were started on LamB and if they develop Acute Kidney Injury (AKI)criteria as per KDIGO2012 guidelines during hospital stay were included in the study after excluding patients with pre existing Chronic Kidney Diseases( CKD),concomitant use of other Nephrotoxic medications,use of nonLAmB formulations for mucormycosis treatment,AKI at the time of admission and critical illness requiring ICU stay.Their demographic characteristics,co morbidities,salient clinical examination findings and laboratory parameters were entered in excel sheet.Descriptive statistics were used to analyse data. Result(s): Mean Age of study population was 51.03 years. Male to female ratio was 25:6.Among comorbidities, Diabetes was seen in 74.19% cases, Hypertension was seen in 35.4% and Ischemic Heart disease was seen 9.6% cases. When risk factors for mucormycosis were analysed 100% of study population had recent COVID19 infection, 93.5% of study population had prior steroid use and 9.6% of the patients had received Tocilizumab. Out of 102 patients who received LAmB 31(30.3%) developed AKI. Among these cases, Stage1 AKI was seen in 8 (25.8 %) cases,Stage 2 AKI was seen in 17 (54.8%) cases and Stage3 AKI was seen in 6 (19.3%) cases. None of these patients had oliguria or requirement of dialysis during hospital stay. 54.8% of patients had persistent AKI at the time of discharge.Hypokalemia was seen in 77.4% cases and 41.9% had severe hypokalemia requiring IV potassium treatment.Hyponatremia was seen in 51.6% cases, most of these cases were mild and only one patient had severe hyponatremia requiring hypertonic saline infusion.Hypomagnesemia was seen in 29 % cases. Conclusion(s): LAmB was associated with significant nephrotoxicity resulting in development of AKI in 30% of cases.Most of these cases had stage 2 AKI and none of them required dialysis support.Almost half of the study population had persistent AKI at the time of discharge.Among the electrolyte disorders,Hypokalemia was particularly severe. No conflict of interestCopyright © 2023