An effective systemic antifungal agent, amphotericin B causes decreased
renal blood flow because of acute renal vasoconstriction in a
dose-dependent manner. Amphotericin causes direct tubular injury also.
Cumulative doses exceeding 2 to 3 g often lead to a distal renal tubular
acidosis, concentrating defects, and potassium wastingj2 Higher doses
usually lead to ATN. Renal failure is usually nonoliguric and reversible
once administration is discontinued.
Enzymuria, magnesium and potassium wasting, and tubular necrosis
can also occur in up to 50% of patients receiving cisplatin.6, 28, 53
Platinum is primarily concentrated in the S-3 segment of the proximal
tubule, but damage can also be seen in the distal tubule and collecting
65 in a dose-dependent fashion. Slow continuous cisplatin infusion
with adequate saline hydration 12 hours preceding infusion and 12
hours postplatinum infusion along with furosemide or mannitol administration
to maintain a urine output of at least 100 mL/hour has been
shown to decrease the incidence of platinum-induced tubular necrosis.
226,2 Other chemotherapeutic agents associated with tubular toxicity
include mithramycin, cyclophosphamide, vincristine, and methotrexate
(see Tables 1 and 2)