[Voriconazole compromises renal function in an elderly CDK patient with Candida albicans infection].

Abstract

There has been a progressive increase in the number of intensive care patients being transferred to nephrology units because of improper dosage of drugs, especially patients with chronic kidney disease (CKD). Voriconazole is a new synthetic triazole derivative with stronger therapeutic activity against fungal infections than fluconazole or itraconazole. Its effectiveness is associated with high nephrotoxicity, affecting patients with CKD in particular. The adverse effects of voriconazole involve several segments of the nephron, particularly the proximal tubule, medullary thick ascending limb, and collecting duct, causing loss of potassium and magnesium and backdiffusion of hydrogen ions. We report the case of an 86-year-old man with moderate CKD who developed acute renal failure as a result of inadequate dosage of voriconazole. He developed oliguria, electrolyte imbalance and fluid overload requiring hemodialysis. Vericonazole withdrawal associated with short daily hemodialysis treatment led to the recovery of diuresis, kidney function, and electrolyte balance. In conclusion, in elderly patients with liver disease and moderate CKD, thorough evaluation is needed before the administration of voriconazole in order to establish the most appropriate dose.

• Authors: Pietro Anastasio, Fabiana Marcarelli, Giancarlo Bilancio, Alessandra Antonia Mele, Natale Gaspare De Santo
• Journal: Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia (G Ital Nefrol) 2010 May-Jun Vol. 27 Issue 3 Pg. 306-11 ISSN: 0393-5590 [Print] Italy
• Vernacular Title: Aggravamento della funzione renale da Voriconazolo in paziente anziano con nefropatia cronica affetto da infezione da Candida albicans.
• PMID: 20540025 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Voriconazole

Topics

• Acute Kidney Injury (chemically induced)
• Aged, 80 and over
• Antifungal Agents (adverse effects)
• Candidiasis (complications, drug therapy)
• Chronic Disease
• Humans
• Kidney Diseases (complications)
• Male
• Pyrimidines (adverse effects)
• Triazoles (adverse effects)
• Voriconazole