amphotericin-b and Nephrotic-Syndrome

Invasive mold infections continue to account for significant morbidity and mortality in immunocompromised patients; outcomes are dependent on both underlying host factors and appropriate therapy. The antifungal armamentarium has gradually increased during the past, with liposomal amphotericin B (L-AMB) being an important representative. Still, the question of what dose to use - a maximum tolerated or a minimum effective - has yet to be answered. On this basis, a randomized trial comparing a high-loading dose regimen with a standard dosing of L-AMB (AmBiLoad trial) for primary therapy of mold infections was initiated. No significant differences in response between the treatment groups were detected, although recipients of the 10-mg/kg daily dose experienced higher rates of nephrotoxicity and hypokalemia. Uncontrolled malignancy and allogeneic stem cell transplantation were significantly associated with poor survival. This article analyzes the study, discusses the rationale and the results and concludes that this study supports the routine application of L-AMB.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Dose-Response Relationship, Drug; Double-Blind Method; Hematologic Neoplasms; Humans; Hypokalemia; Nephrotic Syndrome; Neutropenia; Survival Rate; Treatment Outcome

Mucormycosis is a rare and fatal opportunistic infection occurring in severely immunocompromised patients. Here, we report, for the first time, on a 65-year-old man with idiopathic membranous nephropathy and moderate renal dysfunction who suffered from life-threatening pulmonary mucormycosis during immunosuppressive therapy. After amphotericin B (AmB) administration with a total accumulating dose of 1.5 g, not only has he recovered from this fatal infection, but also his nephrotic syndrome has entered complete and long-term remission without any continued corticosteroid and immunosuppressive therapy during the 6-year follow-up. Serum creatinine levels remained stable by adjusting the tolerable daily dose of AmB during the period of treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Glomerulonephritis, Membranous; Humans; Immunosuppression Therapy; Male; Mucormycosis; Nephrotic Syndrome; Remission, Spontaneous

Renal involvement is a rare complication in HIV-1-infected patients leading to various pathologies and clinical symptoms. In addition to the classic HIV-1-associated nephropathy with collapsing-type focal segmental glomerulosclerosis and characteristic tubulocystic changes, which is more common in Afro-American than in Caucasian HIV-1 patients, immune complex GNs such as membranous GN and membranoproliferative GN are particularly common renal manifestations. Besides HIV-1 itself, a number of opportunistic infections may cause renal disease in HIV-1-infected patients. In this study, we report an unusual case of HIV-1 infection with a severe renal manifestation of systemic leishmaniasis that developed years after repeated visits to Mediterranean countries. The case presents several remarkable clinical, pathologic, and therapeutic aspects that may be important for daily clinical practice.

Topics: Amphotericin B; Anti-HIV Agents; Biopsy, Needle; Follow-Up Studies; HIV Infections; Humans; Immunohistochemistry; Kidney; Kidney Function Tests; Leishmaniasis; Male; Middle Aged; Nephrotic Syndrome; Risk Assessment; Treatment Outcome

A 76 year-old woman was admitted to our hospital because of pyrexia and fatigue. One year earlier, she was diagnosed as nephrotic syndrome(NS) caused by focal segmental glomerulosclerosis and immunosuppressive therapy was started with marked amelioration of proteinuria. Thereafter, her renal function worsened, but only supportive treatment was continued. After admission, a cerebrospinal fluid (CSF) examination revealed Cryptococcus neoformans (C. neoformans) by india ink staining and a subsequent CSF culture confirmed C. neoformans infection. Accordingly, we made the diagnosis of cryptococcal meningitis and immediately started multiple anti fungal drugs with dosage modification according to her impaired renal function. Immunosuppressive therapy for NS was temporarily terminated. The inflammatory signs and symptoms soon were markedly improved, but the anti cryptococcal antibody titer in the serum and CSF remained high. Immunosuppressive therapy was started again at a low dosage because urinary protein had increased again. One hundred and eight days from admission, she was discharged with a regimen of multiple anti fungal drugs. Proteinuria and renal insufficiency was almost stable during hospitalization. Most fungal infection develops in patients in an immunosuppressive state induced by immunosuppressive drugs, HIV infection and so on. Patients with NS are frequently in an immunosuppressive state because of urinary loss of immunoglobulins and the use of immunosuppressive drugs. Therefore, it should be remembered that patients with NS are at a high risk of suffering from fungal infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Cyclosporine; Drug Administration Schedule; Female; Fluconazole; Humans; Immunosuppressive Agents; Meningitis, Cryptococcal; Nephrotic Syndrome; Prednisolone; Renal Insufficiency

Topics: Adult; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Endocarditis; Female; Heart Valve Diseases; Humans; Infusions, Intravenous; Nephrotic Syndrome; Tricuspid Valve

Disseminated cryptococcosis mainly occurs in patients with impaired cell mediated immunity. We present a case of disseminated cryptococcosis in a non-HIV patient with nephrotic syndrome who never received immunosuppression. Cultures of bone marrow aspirate, cerebrospinal fluid analysis and histology of skin lesions were all consistent with Cryptococcus neoformans infection. Treatment with amphotericin B followed by fluconazole was successful and in the course of two months when, the skin nodules disappeared.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Fluconazole; Forearm; Humans; Male; Nephrotic Syndrome; Skin; Treatment Outcome

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antimony; Antiprotozoal Agents; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Nephrotic Syndrome; Organometallic Compounds; Pancreatitis

Topics: Aged; Amphotericin B; Cryptococcosis; Flucytosine; Humans; Immunosuppression Therapy; Male; Nephrotic Syndrome; Prednisone