Nephrotoxicity of Amphotericin B

Abstract

Introduction The nephrotoxicity associated with amphotericin B has beeen the greatest deterrent to its effective use^1-6 in the treatment of systemic mycoses. The precise nature of this toxicity is obscure, and the available descriptions are conflicting. The present report is a study of renal function and morphology during amphotericin B therapy for Coccidioides immitis infections. Material and Methods Six patients with clinical and serologic evidence of disseminated coccidioidomycosis were studied before, during, and after therapy. Two of the patients had no previous treatment. The other four had prior amphotericin B therapy. Clinical details, including cumulative dosages, appear in Tables 1 and 2. Diagnosis of dissemination was based on isolation of C immitis from an extrapulmonary site or a maximum complement fixation titer of at least 1:32 (see Table 1). The diagnosis of coccidioidal meningitis was confirmed by the criteria employed by Einstein et al,⁷ ie, spinal fluid findings