Amphotericin is one of those medications which keeps nephrologists in business by virtue of its predictable nephrotoxic effects. The mechanism of amphotericin-induced renal failure is felt to be acute tubular necrosis (ATN); the drug binds to sterols in cell membranes, creating pores that destroy the plasma membrane--both the fungal plasma membrane as well as renal epithelial cell plasma membranes, which is felt to be the mechanism of its nephroxocity. Amphotericin-induced renal failure is dose-related and rarely develops unless the total dose exceeds 2gm.
In addition to ATN, amphotericin has other notable renal side effects as well: the drug can cause distal (Type I) renal tubular acidosis, nephrogenic diabetes insipidus, and renal potassium and magnesium wasting as well.
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