Klin Onkol 1998; 11(4): 101-106.
Summary: Conventional amphotericin B was discovered in late 1950's. Many side effects of amphotericin B were described early after the introduction of amphotericin B to clinical practice. Renal toxicity is the most serious adverse effect of amphotericin B. Amphotericin B nephrotoxicity can be tubular or glomerular. The tubular toxicity manifests through an increased loss through renal tubuli and subsequent decrease in serum ion concentrations, glomerular filtration decrease and serum creatinine clearance increase. Many experimental studies reporl thiat renal impairment during amphotericin B therapy can be caused by changes in renal blood circulation by a direct amphotericin B effect on renal arteriolae. Therefore, many experimental and clinical studies have been directed at the prevention of amphotericin B nephrotoxicity. However, only hydration with NaCl supplementation has become widespread. In spite of hydration with saline supplementation, amphotericin B nephrotoxicity is frequent. We verify in 32 cancer patients our hypothesis that sufficient hydration of patients with average diuresis of about 3.5—1.0 l/day and potassium, sodium and magnesium supple-mentation corresponding to the amounts lost by the kidneys is an effective prophylaxis for prevention of amphotericin B-induced decrease in creatinine clearance and for countering imbalances in serum electrolyte concentrations during use of conventional amphotericin B. Until the present time litis approach has not been described.
We observed the frequency of amphotericin B infusion-related side-effects, which was minimal at about 10.0%. Infusion-related side-effects can be influenced using non-steroidal anti-inflammatory drugs or low dose hydrocortisone with excellent results.
