Amphotericin B nephrotoxicity
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
Amphotericin B is used in the treatment of often life-threatening fungal infections. (See "Pharmacology of amphotericin B".) Impaired renal function is a relatively common complication of amphotericin B, as are other renal manifestations, including urinary potassium wasting and hypokalemia, urinary magnesium wasting and hypomagnesemia, metabolic acidosis due to type 1 (or distal) renal tubular acidosis, and polyuria due to nephrogenic diabetes insipidus [1-5].
An overview of amphotericin B nephrotoxicity is presented here. The management of hypokalemia, hypomagnesemia, distal renal tubular acidosis, and nephrogenic diabetes insipidus is discussed in detail elsewhere. (See "Clinical manifestations and treatment of hypokalemia in adults", section on 'Treatment' and "Evaluation and treatment of hypomagnesemia", section on 'Treatment' and "Treatment of distal (type 1) and proximal (type 2) renal tubular acidosis", section on 'Distal (type 1) renal tubular acidosis' and "Treatment of nephrogenic diabetes insipidus".)
ACUTE KIDNEY INJURY
Incidence with conventional amphotericin B — Conventional amphotericin B (ie, not the lipid formulations) causes renal vasoconstriction and can reduce the glomerular filtration rate (GFR) by more than half [1-4,6,7]. In the two largest reviews, a 50 percent or greater increase in serum creatinine was observed in 138 of 494 and 174 of 643 patients (28 and 27 percent), respectively [4,6].
The risk of amphotericin-induced renal injury is influenced by other factors:
●Concurrent therapy with other nephrotoxins, such as an aminoglycoside, cyclosporine, or foscarnet, increases the risk of acute kidney injury [4,6-8]. In one report, the incidence of a twofold or greater increase in serum creatinine was 15 percent in patients taking no or one concurrent nephrotoxic drug and 41 percent in those taking two or more concurrent nephrotoxic drugs .
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