Amphotericin B Nephrotoxicity with Irreversible Renal Failure

Abstract

Irreversible renal failure followed the cessation of amphotericin-B therapy. The kidneys removed following allogenic renal homotrans-plantation were only slightly reduced in size but demonstrated a marked reduction in functioning parenchym with extensive interstitial edema and fibrosis. Glomerular damage varied with increased cellularity and epithelial proliferation, crescent formation, focal hyalinization and complete hyalinization. Tubular atrophy was striking as was the compensatory hypertrophy and wide dilatation of tubules. Glomerular and tubular basement membranes were thickened and there was extensive periglomerular fibrosis. There was calcification within the tubular epithelium and the interstitium. The arteries and arterioles were normal. Since the administration of this antibiotic resulted in permanent impairment of renal function and extensive and irreversible renal histologic alterations in both man and dog, the possible correlation between total dose of amphotericin-B and the severity of nephrotoxicity must be considered whenever this agent is employed.