amphotericin-b and Anuria

Invasive candidiasis is a serious pathogen of late-onset sepsis in very low birth weight infants. Kidney is the most common organ involved, and it causes morbidity and mortality, especially when fungal balls are formed. We report a 34-day-old female infant (born at 28 weeks' gestation, 1152 g) with systemic fungal infection complicated obstructive uropathy. On sonography, the fungal balls filled the entire pelvis without hydronephrosis. Percutaneous nephrostomy was not feasible. In addition to systemic antifungals, we successfully performed cystoscopy-assisted retrograde ureteral catheterization to decompress the pelvis, which also provided a route for local amphotericin B irrigation to achieve therapeutic concentration without nephrotoxicity.

Topics: Amphotericin B; Antifungal Agents; Anuria; Candidiasis; Caspofungin; Female; Flucytosine; Humans; Infant; Infant, Very Low Birth Weight; Kidney Diseases; Therapeutic Irrigation; Ultrasonography; Ureteral Obstruction; Urinary Catheterization

We report a case of anuria in a premature neonate secondary to bilateral ureteropelvic junction obstructions related to Candida bezoars. Percutaneous decompression and drainage of both kidneys contributed significantly to the successful management of renal candidiasis in this patient. A review of the literature is presented.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Drainage; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Male; Nephrostomy, Percutaneous

A low birth weight premature neonate with systemic candidiasis developed complete renal obstruction by fungus balls, diagnosed by ultrasonography. The neonate was treated with temporary urinary diversion, amphotericin B, 5-fluorocytosine and survived. This case emphasizes the need for a high index of suspicion of renal obstruction by fungus balls in neonates with systemic candidiasis when renal function deteriorates. In such cases early urinary diversion can be life-saving.

Topics: Amphotericin B; Anuria; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Infant, Newborn; Male; Ultrasonography; Ureteral Obstruction; Urography

A 4 month-old premature infant having received prolonged intensive care for necrotizing enterocolitis and Pseudomonas infection, developed anuria with intrapyelic fungus ball developed in a congenital single kidney. Review of the literature found 19 similar cases and emphasized the difficulty of an early diagnosis and the usefulness of renal ultrasonography for its detection. Moreover the opportunity to treat premature neonates carrying candida albicans with IV amphotericin B and flucytosine before the occurrence of an uneasy treatable urological obstacle in discussed.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Flucytosine; Humans; Infant; Kidney; Kidney Pelvis

Systemic candidiasis with renal involvement is a well recognised complication of intensive care in premature newborns. However, the development of reversible obstructive oliguric acute renal failure has not been well documented. We report a premature infant who developed anuria associated with bilateral candidal bezoar formation in the renal collecting system. The sonographic appearance of the renal fungus balls is described. Treatment by surgical removal of the bezoars, open placement of nephrostomy tubes and intravenous antifungal therapy resulted in apparent complete recovery.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Female; Flucytosine; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Injections, Intravenous; Kidney Diseases; Radiography; Time Factors; Ureteral Diseases

Amphotericin B causes reversible concentration-dependent loss of intracellular potassium in vitro and hyperkalemic ventricular arrhythmias in dogs. Hyperkalemic ventricular arrhythmias associated with amphotericin B infusion have not been well documented in humans. Ventricular fibrillation with progressive hyperkalemia (up to 8 to 8.4 meq/liter) occurred twice in an anuric patient during rapid infusion of high-dose amphotericin B (1.4 mg/kg over 45 min). The peak amphotericin B concentration in serum at the end of infusion was 6.7 micrograms/ml. Prolonged infusion (3 h) and concurrent hemodialysis each prevented the development of hyperkalemia and ventricular arrhythmia. In two anuric patients receiving 4-h infusions of amphotericin B during dialysis (0.7 and 1.0 mg/kg), peak amphotericin B concentrations in serum were lower, 1.6 +/- 0.1 and 2.7 +/- 0.7 micrograms/ml, respectively; serum potassium levels were maintained in the normal range; and venous access for outpatient therapy was convenient. Peak concentrations of amphotericin B in serum were also lower (1.7 +/- 0.7 micrograms/ml) in eight patients with normal renal function who received lower doses (0.7 +/- 0.2 mg/kg) over 45 min; there were only slight increases in the serum potassium level (from 3.9 +/- 0.9 to 4.4 +/- 0.6 meq/liter, P less than 0.05). We recommend that rapid infusion of amphotericin B not be used in patients with impaired potassium excretion unless accompanied by hemodialysis and careful potassium monitoring.

Topics: Adult; Amphotericin B; Anuria; Electrolytes; Female; Humans; Hyperkalemia; Infusions, Parenteral; Potassium; Renal Dialysis; Risk; Ventricular Fibrillation

We report the first case of anuria in a 1-month-old male newborn associated with disseminated candidiasis. Anuria resulted from bilaterally obstructing Candida bezoars. Renal decompression was established with bilateral nephrostomy placement and the renal candidiasis was treated successfully with a combination of parenteral amphotericin B and 5-fluorocytosine.

Topics: Amphotericin B; Anuria; Candidiasis; Diagnosis, Differential; Humans; Infant, Newborn; Male; Ureteral Diseases

Amphotericin B (2.5 mg/kg, administered intravenously) increased vascular resistance (renal more than pulmonary more than systemic) and decreased glomerular filtration and urine flow 94% in 16 anesthetized female mongrel dogs. Dopamine decreased renal vascular resistance 31% in 14 dogs; when amphotericin B was given with dopamine, there was partial antagonism of amphotericin B-induced renal vasoconstriction. Saralasin partially antagonized amphotericin B-induced renal vasoconstriction in seven dogs. When amphotericin B was given during combined infusion of dopamine and saralasin in eight dogs, renal blood flow remained at initial control levels, urine flow increased above initial levels, and glomerular filtration decreased only 21% from initial values. Amphotericin B increased renal vascular resistance 296% when given alone but only 41% in dogs during injection of both dopamine and saralasin (P = 0.002). The antagonism of amphotericin B-induced renal effects by the combination of dopamine and saralasin was significant and specific for the renal vascular bed.

Topics: Amphotericin B; Angiotensin II; Animals; Anuria; Disease Models, Animal; Dogs; Dopamine; Female; Glomerular Filtration Rate; Kidney; Lung; Oliguria; Saralasin; Vascular Resistance

Topics: Adolescent; Adult; Agammaglobulinemia; Amphotericin B; Anuria; Azathioprine; Biopsy; Bis-Trimethylammonium Compounds; Busulfan; Child; Child, Preschool; Chlorambucil; Cyclophosphamide; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Pneumonia, Pneumocystis; Prednisone; Transplantation, Homologous; Vincristine

Topics: Adult; Amphotericin B; Anuria; Candida; Candidiasis; Humans; Kidney Diseases; Male; Urinary Catheterization; Urine; Urography

Topics: Amphotericin B; Animals; Antifungal Agents; Anuria; Blood Urea Nitrogen; Depression, Chemical; Diuresis; Dogs; Female; Glomerular Filtration Rate; Kidney; Kidney Function Tests; Polyuria; Proteinuria; Stimulation, Chemical

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting

Topics: Amphotericin B; Anuria; Coccidioidomycosis; Humans; Kidney; Kidney Diseases; Kidney Function Tests; Toxicology; Uremia