Low serum albumin and the increased risk of amikacin nephrotoxicity.

AIM: The purpose of the present study was to know the incidence and risk factors associated with amikacin nephrotoxicity in a cohort of patients form a general medial center. STUDY DESIGN: Prospective follow-up of a cohort of 104 patients treated with intravenous amikacin for at least 36 hours. We assessed serum creatinine every other day and amikacin plasma levels at 48 and 96 hours after treatment was begun. Patients with other risk factors to develop acute renal failure were excluded. The study was conducted at the Hospital de Especialidades, Centro Médico de Occidente, Instituto Mexicano del Seguro Social. RESULTS: Ten patients developed nephrotoxicity (9.6%). According to the logistic regression model, the most powerful predictor of high nephrotoxicity probability was the serum albumin concentration. The lower the serum albumin concentration, the higher the risk of toxicity. The mean serum albumin in the group of patients with nephrotoxicity was 2.6 +/- 0.55 g/dL, while in the group of patients without toxicity it was 3.5 +/- 0.55 g/dL. No differences were observed in the age, sex, diagnosis, renal function and amikacin doses between both groups. Furthermore, low serum albumin concentration was also associated with amikacin accumulation in plasma. The group of patients with hypoalbuminemia (< or = 3.0 g/dL) had a significantly higher trough amikacin plasma level (assessed at 48 and 96 hours of the initiation of treatment) than those with normal serum albumin, with no differences among the age, sex, baseline renal function and received amikacin doses. CONCLUSIONS: We conclude that serum albumin concentration is the most powerful predictor of amikacin nephrotoxicity. The risk factors observed in the present study are similar to those previously observed by us at the Instituto Nacional de la Nutrición Salvador Zubirán.

[Fetal hemoglobin and the gamma G/gamma A chain ratio in children with acute lymphoblastic leukemia L1 and L2]. / Hemoglobina fetal y relación de cadenas gamma G/gamma A en niños con leucemia aguda linfoblástica L1 y L2.

PURPOSE: To search in children with acute lymphoblastic leukaemia (ALL) for specific pattern of expression of foetal haemoglobin (HbF) and its G gamma/A gamma chain ratio. MATERIAL AND METHODS: 60 children with ALL were examined: 29 with ALL-L1, and 31 with ALL-L2, and 25 healthy children as control group, which were subdivided in three groups: A) 0-5, B) 6-10 and C) 11-18 years. We performed HbF and HbA2 quantification and Hb electrophoresis. G gamma and A gamma globin chain percentages were obtained with a new method based on the precipitation of the HbF eluate by Singer's method with sulphosalycilic acid, the globin chains were separated in polyacrylamide with Triton X-100 and quantified by densitometry. RESULTS: HbF showed similar levels in both ALL groups by the Betke and Singer's methods; (ALL-L1: 2.2 +/- 1.5%, ALL-L2: 2.0 +/- 1.2%; and ALL-L1: 2.0 +/- 1.2%, ALL-L2: 2.1 +/- 1.5% respectively), but there were statistically significant differences (p < 0.001) when compared with the control group (0.9 +/- 0.4%, and 1.0 +/- 0.6% for Betke and Singer's method). The G gamma/A gamma ratio showed to be different between the ALL-L1 and ALL-L2 (p < 0.001), with higher levels of G gamma in ALL-L1 (51.0%), the ALL-L2 and the control group showed similar G gamma values (37.5% and 42.1% respectively). CONCLUSION: The factors involved in the increase of HbF are similar for both ALL-L1 and ALL-L2. However there seems to be different factors affecting the expression of G gamma or A gamma.