Mechanisms and management of amphotericin B-induced nephrotoxicity.

PURPOSE: The author outlines the care of patients receiving intravenous amphotericin B, with emphasis on the prevention and/or management of nephrotoxicity. OVERVIEW: The immunocompromised patient remains at risk for systemic fungal infections; however, therapeutic options are limited. Although amphotericin B has remained the drug of choice for more than 30 years, its toxic effects, particularly nephrotoxicity, warrant careful attention. Nephrotoxicity is the most serious and dose-limiting effect of amphotericin B therapy. Appropriate assessment before, during, and after therapy in patients receiving intravenous amphotericin B may help to minimize the potential for nephrotoxicity. CLINICAL IMPLICATIONS: To provide optimal patient care, it is imperative that the clinician understand the etiology of and the signs and symptoms associated with nephrotoxicity, as well as interventions to prevent nephrotoxicity, in the patient receiving amphotericin B.