Nephrotoxicity

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    Aminoglycosides
     

    Nephrotoxicity is diagnosed by a rise in serum creatinine above baseline. In its early form it is usually asymptomatic, which means it is very important to monitor serum creatinine while on aminoglycosides.

     

    Symptomatic cases may present with decreased urine output, evidence of volume overload (oedema, anasarca or shortness of breath) or uremic symptoms such as mental status changes (confusion, drowsiness).

     

    Comorbidities such as diabetes or chronic renal failure are not a contra-indication to treatment with aminoglycosides, though caution must be exercised in such circumstances.

    • If renal failure occurs:
      • Stop the aminoglycoside.
      • Rule out other causes of renal failure (e.g. diabetes, dehydration, other drugs, congestive heart failure, urinary obstruction, urinary tract infection, prostate hypertrophy).
      • Adjust doses of other TB drugs to creatinine clearance (Appendix 12).
      • Monitor serum creatinine and electrolytes every 1 to 2 weeks until stable.
    • If renal function stabilises or improves and if the drug is essential, resume the aminoglycoside adjusted to creatinine clearance (Appendix 12).

     

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