Search
aminoglycoside nephrotoxicity
Epidemiology:
1) common cause of hospital-acquired acute renal failure
2) risk increases with patient's age, volume-depletion & pre-existing renal disease
3) relatively low mortality
4) increases cost of hospitalization
Pathology:
1) aminoglycosides accumulate in proximal tubular epithelial cells
2) oncosis of proximal tubular epithelial cells (ATN)
3) reversible abnormalities herald nephrotoxicity
a) glycosuria
b) enzymuria
c) aminoaciduria
d) tubular proteinuria (beta-2 microglobulin)
4) renal K+ & Mg+2 wasting, polyuria & nephrogenic diabetes insipidus may occur
Clinical manifestations:
1) generally manifests as non-oliguric acute tubular necrosis when the sole cause of renal dysfunction
2) decreased GFR may not become apparent for 1-2 weeks
Laboratory:
1) urine Na+ is generally > 40 meq/L
2) fractional excretion of Na+ (FENA) is > 1.5%
Management:
1) therapeutic levels of aminoglycosides should be monitored daily
2) dosage should be adjusted for creatinine clearance
3) discontinue aminoglycoside at 1st sign of nephrotoxicity
Related
acute tubular necrosis; tubulorrhexis (ATN)
aminoglycoside antibiotic
oncosis (ischemic cell death)
References
Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998