Otologic symptoms in chronic renal failure. The possible role of aminoglycoside-furosemide interaction.

Abstract

In the light of a number of reports about otologic symptoms in chronic renal failure, hemodialysis and kidney transplantation we report the findings in a greater material. The material comprises in total 281 patients, 19 in regular, longtime hemodialysis and 262 with one or more kidney transplantations. The frequency of otologic symptoms was 10%, corresponding to 26 patients, of which 3 had Alport's syndrome and not investigated further. The group with otologic symptoms had significantly more hemodialysis, and marginally larger amounts of ototoxic medication. Otherwise the groups do not diverge. When disregarding 6 patients, where other explanation of the patients symptoms is more likely (hemodynamic conditions in connection with operation, congenital hearing loss and one case of Meniere's disease), we find that ototoxic medication probably is the main cause of the otologic symptoms. In particular attention is paid to a possible interaction between aminoglycosides (especially Gentamycin) and diuretics (Furosemide). We find, however, that the majority of the patients do not develop otologic symptoms, and these symptoms are not the direct result of renal failure itself but are due to a complex blend of exogenous and endogenous factors. The material includes only one patient who obtained normal hearing after successful transplantation, and where uremic intoxication migh have been releasing. In the light of several reports about frequent occurrence of acoustic-vestibular symptoms in patients with chronic renal failure, treated with peritoneal dialysis, hemodialysis and/or kidney transplantation, we report our findings concerning the symptoms in a number of patients from the nephrological unit, Rigshospitalet.