Nephrotoxicity of amphotericin B, with emphasis on changes in tubular function

Abstract

Eight patients were treated with amphotericin B; all showed at some time a pronounced fall in glomerular filtration rate and renal blood flow with a variable change in filtration fraction. The maximal decrease was not dose related. The most consistent change in proximal tubular function was an increase in the clearance of uric acid which rose with increasing dosage of amphotericin B and varied inversely with the glomerular filtration rate. The major changes in distal tubular functions were (1) increased clearance of potassium as the dose of amphotericin B increased and glomerular filtration rate fell; (2) development of renal tubular acidosis in five of six patients, the primary change being decrease in titratable acidity; and (3) in the absence of an acid load, a rise in urine pH or fall in hydrogen ion excretion tended to precede a significant fall in glomerular filtration rate. To detect this we stress the use of an acid-ash diet and daily determination of urine pH.