Therapy with amphotericin B deoxycholate can result in renal injury. The risk of nephrotoxicity is increased if certain factors are present.


Risk Factor

Action to Decrease Risk of Nephrotoxicity

pre-existing renal dysfunction

consider therapy with lipid amphotericin B or non-polyene antifungal

dehydration (hypovolemia)


heart failure (relative hypovolemia)


third spacing (relative hypovolemia)


renal infection (adenovirus, CMV, other)




therapy with concurrent nephrotoxins (see below)

avoid if possible, else carefully monitor renal function

total dose of amphotericin B > 500 mg


myeloma, amyloidosis, and/or light chain disease (due to renal disease)


tumor lysis syndrome

keep well hydrated and treat with allopurinol


Potential nephrotoxins:

(1) cyclosporin A

(2) tacrolimus

(3) foscarnet

(4) aminoglycosides

(5) radiocontrast imaging agents

(6) cis-platininum

(7) pentamidine


Reducing the risk of nephrotoxicity:

(1) slow infusion over 24 hours

(2) salt loading (infusion of normal saline) if able to tolerate salt and fluid load (500 mL before, addition after)


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