Nefrotoxicidad en pacientes sida con histoplasmosis sistémicas bajo tratamiento de anfotericina B deoxicolato
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Medicina
Resumen
El presente trabajo investigativo tiene el propósito de determinar la nefrotoxicidad ocasionada por el tratamiento con anfotericina b Deoxicolato en personas con histoplasmosis sistémica. En el hospital de Infectología (Dr. José Daniel Rodríguez Maridueña)
La Anfotericina b Deoxicolato se asocia a reacciones adversas durante la infusión entre ellas la más grave que es la nefrotoxicidad.
El 100% de pacientes presentaban un cuadro clínico similar al momento del ingreso, caracterizado por fiebre no cuantificada, astenia, episodios diarreicos crónicos, malestar general y tos de 2 semanas de evolución y en pocos casos signos de afectación neurológica.
Los principales diagnósticos diferenciales fueron entre tuberculosis extra-pulmonar, pulmonar, diarreas por Isospora belli, Criptosporidium, Microsporidium.
Los resultados del estudio con un total de 180 pacientes con histoplasmosis su afectación por genero fue 80% en varones y 20% a mujeres, el rango de edad más afectado fue de 30-39 años con un 41,7%, recibieron una dosis estándar de anfotericina de 50 mg por día con una duración promedio de 12 días, mientras mayor era la dosis acumulada mayor era la afectación renal, se evaluaron principalmente 3 parámetros: alteraciones de niveles de potasio, urea y creatinina; la hipokalemia estuvo presente en un 42,2% de pacientes (76) esta cifra se explica a que todos los pacientes recibieron reposiciones electrolíticas con potasio intravenoso, se tomó en consideración a la elevación de creatinina sérica basal con más 0,5 previo al tratamiento, asi en los primeros 3 días llego 26,7% (48) cifra que aumento mientras mayor era la duración del tratamiento llegando a 58,9% (106) a los 12 días del tratamiento. La urea aumento paralelamente a la creatinina indicando así fallo renal temprano en 52,8% (95).
Posterior al tratamiento se recabaron valores de hemoglobina para evaluar la presencia de daño renal agudo un 95% de pacientes presentaron niveles de hemoglobina disminuidos y un 15,6% presentaban anemia severa.
PALABRAS CLAVE: anfotericina, nefrotoxicidad, VIH, creatinina, histoplasmosis.
The present investigative work has the purpose of determining the nephrotoxicity caused by treatment whit amphotericin B Deoxycholate in people with systemic histoplasmosis. In the hospital of Infectology (Dr. José Daniel Rodríguez Maridueña) Amphotericin b Deoxycholate is associated with adverse reactions during the infusion, among them the most serious is nephrotoxicity. 100% of patients presented a similar clinical picture to the time of admission, characterized by not quantified fever, asthenia, chronic diarrheal episodes, general ailment, cough of 2 weeks of evolution and in a few cases signs of neurological involvement. The main differential diagnoses were pulmonary and extra-pulmonary tuberculosis, diarrhea due to isospora belli, cryptosporidium, microsporidium. The results of the study with a total of 180 patients with histoplasmosis were, gender affection 80% in men and 20% in women, the age range most affected was 30 to 39 years with 41.7%, they received a standard dose of amphotericin of 50 mg per day with a duration of 12 days, the greater the cumulative dose the greater the renal affectation, it was, we evaluated mainly 3 parameters, alterations of potassium levels, urea and creatinine; Hypokalemia was present in 42.2% of the patients (76), this can be explained because all patients received electrolyte replacement with intravenous potassium, the serum creatinine levels that increased by 0.5 during the first 3 days reached the 26.7% (48) The number inreased to 58.9% (106) at 12 days of treatment. Urea increased parallel to creatinine, indicating early renal failure in 52.8% (95). Hemoglobin levels post treatment were evaluated, in 95% of patients had decreased hemoglobin levels and 15.6% had severe anemia. KEY WORDS: amphotericin, nephrotoxicity, HIV, creatinine, histoplasmosis.
The present investigative work has the purpose of determining the nephrotoxicity caused by treatment whit amphotericin B Deoxycholate in people with systemic histoplasmosis. In the hospital of Infectology (Dr. José Daniel Rodríguez Maridueña) Amphotericin b Deoxycholate is associated with adverse reactions during the infusion, among them the most serious is nephrotoxicity. 100% of patients presented a similar clinical picture to the time of admission, characterized by not quantified fever, asthenia, chronic diarrheal episodes, general ailment, cough of 2 weeks of evolution and in a few cases signs of neurological involvement. The main differential diagnoses were pulmonary and extra-pulmonary tuberculosis, diarrhea due to isospora belli, cryptosporidium, microsporidium. The results of the study with a total of 180 patients with histoplasmosis were, gender affection 80% in men and 20% in women, the age range most affected was 30 to 39 years with 41.7%, they received a standard dose of amphotericin of 50 mg per day with a duration of 12 days, the greater the cumulative dose the greater the renal affectation, it was, we evaluated mainly 3 parameters, alterations of potassium levels, urea and creatinine; Hypokalemia was present in 42.2% of the patients (76), this can be explained because all patients received electrolyte replacement with intravenous potassium, the serum creatinine levels that increased by 0.5 during the first 3 days reached the 26.7% (48) The number inreased to 58.9% (106) at 12 days of treatment. Urea increased parallel to creatinine, indicating early renal failure in 52.8% (95). Hemoglobin levels post treatment were evaluated, in 95% of patients had decreased hemoglobin levels and 15.6% had severe anemia. KEY WORDS: amphotericin, nephrotoxicity, HIV, creatinine, histoplasmosis.
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Anfotericina B, Nefrotoxicidad, Virus de inmunodeficiencia humana, Creatinina, Histoplamosis, Cantón Guayaquil, Ecuador, Hospital de Infectologia Dr. José Daniel Rodríguez Maridueña, Síndrome de inmunodeficiencia adquirida, Estudios retrospectivos