amphotericin-b and Hypertension

Topics: Aged; Amphotericin B; Antifungal Agents; Caspofungin; Diabetes Mellitus, Type 2; Disease Susceptibility; Drug Resistance, Multiple, Fungal; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Glaucoma; Humans; Hypertension; Intravitreal Injections; Lipopeptides; Male; Phialophora; Pyrimidines; Triazoles; Vitrectomy; Voriconazole

The description of the association between the use of amphotericin-B (amB) and the development of systemic arterial hypertension was only anecdotal so far. We describe the case of a 19-year-old female patient who had acute lymphoblastic leukemia and developed prolonged neutropenia after reinduction chemotherapy. Candida parapsilosis was isolated from blood cultures, and amB was started. Sustained severe arterial hypertension developed shortly after amB administration and continued for several hours after the infusion. Aldosterone, blood urea nitrogen, and creatinine levels were normal. After clinical improvement, amB was replaced by fluconazole, and blood pressure normalized. Severe hypertension may be an adverse event associated with AmB treatment that requires intensive treatment.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Follow-Up Studies; Humans; Hypertension; Severity of Illness Index

Topics: Amphotericin B; Antifungal Agents; Humans; Hypertension

Amphotericin B (AmB) continues to be the mainstay of therapy for serious fungal infections, despite its relatively toxic side-effect profile. Lipid preparations of the medication have been marketed in the past few years in an attempt to reduce some of these side effects, especially nephrotoxicity. Although 6 cases of severe hypertension associated with the use of AmB deoxycholate have been reported in the literature, no cases of hypertension associated with a lipid-containing preparation of the medication have been reported. We report here the first case of severe hypertension associated with the infusion of AmB lipid complex (ABLC) in a patient with multiple intraperitoneal and urinary fungal pathogens. We also provide a brief review of the previously reported cases of hypertension associated with the deoxycholate formulation of AmB.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Child; Drug Combinations; Female; Humans; Hypertension; Male; Middle Aged; Phosphatidylcholines; Phosphatidylglycerols

Dietary sodium restriction has several clinical benefits, particularly that of enhancing the antihypertensive action of diuretics and other blood pressure-lowering drugs. In individuals who form hypercalciuric stones, sodium restriction along with thiazide diuretics helps to reduce urinary calcium. However, there are adverse consequences of sodium restriction, particularly in elderly patients with impaired sodium conservation mechanisms. Ischemic and nephrotoxic injuries are induced more readily in sodium-depleted animals and patients because of impaired renal hemodynamics and activation of the renin-angiotensin system. Acute renal failure can be precipitated by sodium restriction and concomitant angiotensin-converting enzyme inhibitors, nonsteroidal antiinflammatory drugs, and immunosuppressive drugs. Dietary sodium restriction in animals enhances the chronic nephrotoxicity of cyclosporine and tacrolimus, whereas similar doses of these drugs do not produce structural damage in salt-replete animals. Maneuvers that block angiotensin II protect against renal scarring and drug-induced arteriolopathy in this model. Sodium restriction can enhance the renal tubular reabsorption of drugs such as lithium, leading to toxic blood concentrations. Calcium antagonists may have better efficacy when prescribed to salt-replete hypertensive persons. Finally, there is evidence that activation of the renin-angiotensin system by sodium depletion will enhance the growth of cysts in animal models of cystic renal disease. In individual patients, the effects of sodium restriction by diet should balance anticipated benefits against any possible adverse consequences.

Topics: Acute Kidney Injury; Aminoglycosides; Amphotericin B; Angiotensin-Converting Enzyme Inhibitors; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antihypertensive Agents; Cisplatin; Contrast Media; Diet, Sodium-Restricted; Food-Drug Interactions; Humans; Hypertension; Immunosuppressive Agents; Renal Circulation

During the past decade, attention has focused on the effects of calcium antagonists on renal function. Recent studies using diverse videomicroscopic techniques including the isolated perfused hydronephrotic rat kidney model, which permits direct visualization of afferent and efferent arterioles, have demonstrated that calcium antagonists acutely antagonize preglomerular vasoconstriction. In contrast, most studies suggest that the efferent arteriole appears to be refractory to the vasodilatory effects of these agents. Although the clinical implications of such observations have not been fully delineated, the results of recent studies indicate that calcium antagonists exert salutary effects on renal function in clinical settings characterized by impaired renal hemodynamics, including transplant-associated acute renal insufficiency and, possibly, cyclosporine nephrotoxicity. Evidence has accrued to suggest that calcium antagonists also may be protective against acute radiocontrast-induced nephrotoxicity. Finally, the renal hemodynamic and natriuretic effects of calcium antagonists commend their use as antihypertensive agents in the management of essential hypertension and transplant-associated hypertension.

Topics: Acute Kidney Injury; Amphotericin B; Animals; Calcium Channel Blockers; Contrast Media; Diabetic Angiopathies; Forecasting; Humans; Hypertension; Kidney Failure, Chronic; Kidney Transplantation

We evaluated an amphotericin treatment strategy on the basis of duration of candidemia and clinical findings. Patients without neutropenia who had uncomplicated candidemia received 200 mg of amphotericin B over 5-7 days if they had had 1 day of positive cultures (PC group). The clinical cure rate was 93% (95% confidence interval [CI], 77%-99%; n=29 episodes) in the SC group, with no relapses (median follow-up, 272 days). The clinical cure rate was 83% (95% CI, 64%-94%; n=29 episodes) in the PC group, with 1 relapse (4.2%). The results of this pilot study suggest that patients with candidemia may be stratified into risk groups on the basis of the duration of positive blood cultures and other clinical findings. Decisions about the duration of therapy can be made 4-7 days after initiation of treatment. Carefully selected patients with transient uncomplicated candidemia may be safely treated with a short course of amphotericin B. Further prospective validation of this concept should be undertaken particularly to evaluate the impact on low-frequency late complications (e.g., endophthalmitis).

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Chest Pain; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Pilot Projects; Recurrence; Survival Rate; Time Factors; Treatment Outcome

Undesirable complement (C) activation by nanomedicines can entail an adverse immune reaction known as C activation-related pseudoallergy (CARPA) in sensitive patients. The syndrome includes cardiopulmonary, hemodynamic, and a variety of other physiological changes that have been well described in man, pigs, dogs, and rats. However, the information on CARPA is scarce and ambiguous in mice, a species widely used in preclinical studies. The present study aimed to fill this gap by exploring signs of CARPA in mice following i.v. administration of AmBisome and Abelcet, which are nano-formulations of Amphotericin B with high risk to cause CARPA.. Anesthetized NMRI mice were intravenously injected with liposomal amphotericin B (Abelcet and AmBisome; 30-300 mg phospholipid/kg), drug-free high cholesterol multilamellar vesicles (HC-MLV), and positive controls, cobra venom factor (CVF) and zymosan, followed by the measurement of blood pressure (BP), heart rate, white blood cell, and platelet counts and plasma thromboxane B2 (TXB2) levels. C activation was assessed by C3a ELISA, a C3 consumption assay (PAN-C3) and a modified sheep red blood cell hemolytic assay.. All test agents, except HC-MLV, caused transient hypertension, thrombocytopenia, and elevation of plasma TXB2, which were paralleled by significant rises of plasma C3a in CVF and zymosan-treated animals, wherein the initial hypertension turned into hypotension and shock. Abelcet and AmBisome caused minor, delayed rise of C3a that was not associated with hypertension. The C3a receptor inhibitor SB-290157 attenuated the hypertension caused by Abelcet and decreased the BP thereafter.. The parallelism between C3a anaphylatoxin production and severity of physiological changes caused by the different agents is consistent with CARPA underlying these changes. Although the reactive dose of liposomal phospholipids was substantially higher than that in other species (pigs, dogs), the mouse seems suitable for studying the mechanism of hypersensitivity reactions to liposomal formulations of amphotericin B, a frequent side effect of these drugs.

Topics: Amphotericin B; Animals; Blood Pressure; Complement Activation; Heart Rate; Hemodynamics; Hypertension; Immunity, Innate; Liposomes; Male; Mice, Inbred C57BL; Physiological Phenomena; Receptors, Complement

The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis.\ A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed.\ A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma.\ Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a “watch and wait” basis.\ Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Topics: Aged, 80 and over; Alzheimer Disease; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Histoplasma; Histoplasmosis; Humans; Hypertension; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Lymph Nodes; Opportunistic Infections; Watchful Waiting

A 7-year-old boy presented with a chronic, indurated, tender left thigh swelling in association with a hypertensive emergency. He had a bilateral moderate degree of hydronephrosis and a left perinephric abscess, and MRI features of posterior reversible encephalopathy syndrome. Histopathological examination of the biopsy specimen demonstrated eosinophilic fasciitis with filamentous fungi. Basidiobolus ranarum was isolated from the culture. The fungus was also isolated from a perinephric fluid aspirate. Computerised tomography of the abdomen demonstrated features consistent with fungal invasion of the pelvic floor muscles and urinary bladder, leading to bilateral hydronephrosis. He required multiple antihypertensive drug therapy and was treated with intravenous amphotericin B, oral itraconazole and potassium iodide. Antihypertensive agents were discontinued after 2 weeks of antifungal therapy. At 6-months follow-up, the hydronephrosis had resolved completely. Perinephric abscess associated with basidiobolomycosis has not been reported previously.

Topics: Abscess; Amphotericin B; Antifungal Agents; Antihypertensive Agents; Biopsy; Child; Entomophthorales; Histocytochemistry; Humans; Hydronephrosis; Hypertension; Itraconazole; Magnetic Resonance Imaging; Male; Microscopy; Perinephritis; Potassium Iodide; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome; Zygomycosis

Acute kidney injury (AKI) following admission to hospital is associated with increased mortality, morbidity and length of stay. Factors that predispose patients to AKI frequently co-exist. The precise description of their representation in unselected admissions could help define mechanistic inter-relationships and optimise risk stratification strategies. Our aim was therefore to define precisely, using electronically available data, the variables that are associated with AKI.. A cohort study of 112,987 emergency admissions to an urban academic medical centre between 2006 and 2010 was performed. Post-admission AKI was defined using KDIGO aligned, proportionate changes in serum creatinine, denominated by the first measured. AKI correlated with co-morbidities, medications received and the C-reactive protein concentration (CRP).. The relationship between post-admission AKI and putative risk factors was defined in univariate and multivariate analyses. Inclusion of CRP in multivariate analyses significantly reduced the strength of association between some co-variables such as radiological contrast and gentamicin administration but not others.. The effect of CRP in these analyses supports the role of systemic inflammation in susceptibility to post-admission AKI. It accounts for the greater part of univariate associations between AKI and some nephrotoxic agents, placing the risk attributable to their use in context. Quantification of the systemic inflammatory response may have utility in AKI risk stratification, integrating various determinants of susceptibility.

Topics: Academic Medical Centers; Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Amphotericin B; C-Reactive Protein; Comorbidity; Creatinine; Diabetes Mellitus; Emergencies; Female; Gentamicins; Hospitalization; Hospitals, Urban; Humans; Hypertension; Inflammation; Male; Middle Aged; Risk Assessment; Risk Factors

To determine the frequency of yeast in the oral cavity of patients with chronic renal failure, undergoing hemodialysis (PCRFH); identification and antifungal susceptibility profile of yeast and demographic profile of patients.. We performed mouthwash in 146 PCRFH; the rinse fluid was collected and cultured, yeasts grown were identified by phenotypic and molecular methods. The antifungal susceptibility profile was determined against nystatin, amphotericin B, fluconazole, voriconazole, and caspofungin based in Clinical and Laboratory Standards Institute (document M27-A3).. Positive culture was observed in 39% of patients, of whom 53% were women; the median of dialysis time was 2.9 years. The age of the colonized patients varied between 26 and 84 years, with a median of 52.5 years. PCRFH over 45 years were significantly more colonized (P = 0.0108) as well as denture wearers (84.0%). We isolated 81 yeasts, predominantly Candida albicans (63%) followed by Candida glabrata. In general, yeasts were sensitive to the evaluated antifungal agents, but there was significant variation in the minimum inhibitory concentration, especially among non-C. albicans Candida (NCAC) compared to fluconazole, caspofungin, and amphotericin B. NCAC required significantly higher concentrations of fluconazole (P < 0.01).. The rate of colonization by yeasts in PCRFH was high, and there was variability in species distribution and antifungal susceptibility profile. These results are little known in this group of patients and are important for controlling the risk of developing invasive fungal infections.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Caspofungin; Colony Count, Microbial; Dentures; Diabetes Complications; Echinocandins; Female; Fluconazole; Humans; Hypertension; Kidney Failure, Chronic; Lipopeptides; Male; Microbial Sensitivity Tests; Middle Aged; Mouth; Mycology; Nystatin; Phenotype; Pyrimidines; Renal Dialysis; Time Factors; Triazoles; Voriconazole

We report a case of Candida glabrata perinephric abscess in a patient with diabetes mellitus who recently underwent ureteropelvic surgery for lithiasic urinary tract obstruction. Surgical drainage and amphotericin B treatment led to resolution of the infection. C. glabrata urinary infection has become more prevalent over the last decade in immunocompromised patients. Drainage is indicated for development of a fungal abscess in the perinephric area. Most authors recommend administration of an antifungal adjuvant treatment.

Topics: Abscess; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Escherichia coli Infections; Female; Humans; Hypertension; Immunocompromised Host; Kidney Diseases; Postoperative Complications; Risk Factors; Serotyping; Urinary Calculi; Urinary Tract Infections

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Humans; Hypertension; Male; Meningitis, Cryptococcal; Middle Aged

Topics: Amphotericin B; Candidiasis, Cutaneous; Child; Humans; Hypertension; Male

Between 1975 and 1988, 92 pediatric patients have undergone bone marrow transplantation (BMT) at our institution for malignant or immune deficiency disease. We evaluated in a retrospective fashion 64 of these patients who survived beyond the first 60 days post-BMT. The clinical course was divided into: less than 60 days post-BMT (early) and greater than 60 days post-BMT (late). The presence or absence of renal insufficiency was noted as well as all known potential factors predisposing to insufficiency. Step-wise regression analysis was then performed to determine which of the factors were most significantly associated with renal dysfunction during the two periods. The follow-up period was 2 months to 11 years (mean 17.5 months). The mean age of the patients was 7.6 years (1 month-18 years). Fifty percent of the patients had renal insufficiency during the early period and 28% of the patients had insufficiency after the initial 60 days. Three major predictors of renal insufficiency were discovered. Cyclosporin A or amphotericin B early or late post-BMT was independently predictive of developing insufficiency during the same period. Conditioning with total body irradiation was a predictor for insufficiency in both periods. Early insufficiency was not predictive of late insufficiency. Hypertension was present in 31% of patients during the early period and in 16% during the late period. Hypertension was strongly associated with cyclosporin use and renal insufficiency. Renal insufficiency is a frequent sequela in children following BMT and likely results from a combination of radiation injury and drug toxicity.

Topics: Adolescent; Amphotericin B; Bone Marrow Transplantation; Child; Child, Preschool; Cyclosporins; Follow-Up Studies; Graft Rejection; Humans; Hypertension; Infant; Kidney Diseases; Regression Analysis; Retrospective Studies

Several abnormalities of cation transport have been described in the Milan hypertensive rats (MHS). In this study we examined Na,K-ATPase activity in proximal convoluted tubules (PCT) cells and medullary thick ascending limb of Henle cells (TAL) from MHS and from the Milan normotensive rats (MNS). Na,K-ATPase activity was determined as 32P-ATP hydrolysis in single tubule segments. Na,K-ATPase activity (pmol Pi/mm t/h) was significantly higher in MHS than MNS both in PCT (903 +/- 227 n = 8 v 506 +/- 285 n = 12) and TAL (4324 +/- 800 n = 5 v 3063 +/- 625 n = 5). Na,K-ATPase dependent respiration was determined in PCT cell from MNS and MHS. Under basal condition Na,K-ATPase dependent respiration (mumol O2/mg protein/h) was higher in MHS than in MNS (24.2 +/- 1.8 n = 5 v 16.1 +/- 0.4 n = 5). When the cells were Na loaded by amphotericin Na,K-ATPase dependent respiration increased significantly more in MHS than MNS (38.4 +/- 1.6 v 26.8 +/- 2.2 n = 4). Thus, Na,K-ATPase activity is higher in renal tubule cells both at normal intracellular Na and after the cells have been Na loaded. The results indicate that regulation of Na homeostasis in renal tubule cell is different in MHS and MNS.

Topics: Amphotericin B; Animals; Hypertension; In Vitro Techniques; Kidney Tubules; Loop of Henle; Male; Ouabain; Oxygen Consumption; Rats; Rats, Inbred SHR; Rats, Inbred Strains; Sodium-Potassium-Exchanging ATPase

Primary renal candidiasis and hydronephrosis were diagnosed in two premature neonates in whom systemic hypertension developed. The clinical course in these patients and in 16 patients with renal candidiasis described in the literature indicated that prematurity, use of broad-spectrum antibiotics, and use of intravenous (IV) catheters are predisposing factors. Anuria and flank mass were the initial manifestations in the reviewed cases. Only four of the 16 patients survived following either antifungal therapy or nephrectomy. Both of our patients survived after antifungal therapy with amphotericin B and flucytosine for systemic effect as well as topical instillation of amphotericin B solution via a nephrostomy. We believe that a high index of suspicion in infants at risk and early institution of antifungal therapy for systemic as well as topical effect can improve the outcome in infants with renal candidiasis.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Female; Flucytosine; Humans; Hydronephrosis; Hypertension; Infant; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Kidney Pelvis; Male

Topics: Amphotericin B; Hospitalization; Hypertension; Methods; Mycoses; Patient Compliance; Research; Terminal Care; United States

Topics: Adolescent; Adult; Amphotericin B; Animals; Asian People; Cerebrospinal Fluid Proteins; Child; Columbidae; Cryptococcosis; Cryptococcus neoformans; Cytosine; Evaluation Studies as Topic; Female; Glucose; Humans; Hypertension; Lung Diseases; Male; Meningitis; Middle Aged; Myasthenia Gravis; Peptic Ulcer; Prognosis; Schizophrenia; Singapore; Tuberculosis, Meningeal

Topics: Adenoma; Adrenal Gland Neoplasms; Amphotericin B; Candidiasis; Cushing Syndrome; Diabetes Mellitus; Endocarditis; Female; Humans; Hydrocortisone; Hypertension; Infant