Aminoglycoside-Induced Acute Tubular Necrosis

Aminoglycoside-Induced Acute Tubular Necrosis
By:Raniah Al-Jaizani M.Sc
Classification of ARF

Glomerular & Tubular Functions
Aminoglycoside-Induced ATN
Rank order of nephrotoxicity:
To prevent aminoglycoside-induced nephrotoxicity inclinical practice:
Amphotericin B-Induced Nephrotoxicity
Assignments:
Diabetic nephropathy
ESRD = End Stage Renal Disease
DM & Kidney Disease
ESRD in type I DM
DM = Diabetes Mellitus
ESRD = End Stage Renal Disease
DM & Diabetic Nephropathy
BP = Blood Pressure
Natural History of Diabetic Nephropathy
Hyperfiltration
Silent phase
Incipient nephropathy
nephropathy Stage 4
Onset of proteinuria
ESRD
Dialysis/Transplant
Diabetic Nephropathy & Albuminuria
* Albuminuria is the earliest sign of kidney involvement in patients with DM
* It correlates with the rate of progression of kidney disease
* Type I DM >5 years test for albuminuria annually
* Type II DM test for albuminuria annually starting from time of diagnosis
* The presence of albuminuria indicates irreversible kidney damage

Management Goals
* Delay the need for dialysis therapy as long as possible
* Manage 2ry complications
Management Strategies
* Intensive glucose control
* Antihypertensive therapy
* Dietary protein restriction

Intensive Glucose Control
* Glycemic control is indicated to reduce proteinuria & slow the rate of decline in GFR
* The ADA recommended goals:
* Pre-prandial plasma glucose = 90 – 130 mg/dl
* Peak post-prandial plasma glucose < 180 mg/dl
* Hgb A1C < 7%
GFR = Glomerular Filtration Rate
ADA = American Diabetes Association’s
Antihypertensive Therapy
* Untreated HTN is associated with reduction in GFR
* The control of BP has been shown to slow the progression of kidney disease and increase life expectancy in DM patients
HTN = HyperTeNsion
BP = Blood Pressure
Antihypertensive Therapy
* To control BP ACEIs or ARBs are the preferred agents
* They have been shown to reduce proteinuria & decrease rate of decline in GFR
* They are used an all diabetic patients & microalbuminuria even if their BP is normal
* BP goal in patients with DM & kidney disease is < 130/80 mm Hg
ACEIs= Angiotensin Converting Enzyme Inhibitors
ARBs = Angiotensin Receptor Blockers
Dietary Protein Restriction
Patient Case
Laboratory values:

Aminoglycoside-Induced Acute Tubular Necrosis.ppt