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A Simple Test to Predict Gentamicin Nephrotoxicity

Dan Aderka, MD; Michal Tene, MD; Eran Graff, PhD; Yoram Levo, MD

Arch Intern Med. 1988;148(5):1093-1096.

Abstract
• The initial target of aminoglycoside nephrotoxicity is the proximal tubule. Yet, no simple test is available to predict such toxicity. Taking advantage of the fact that amylase is filtered in the glomerulus and reabsorbed by the proximal tubules, we prospectively examined in 23 patients if changes in renal amylase creatinine clearance ratio (ACCR) can predict gentamicin nephrotoxicity. Eighteen of these patients had an initial creatinine clearance (rCcr) above 30 mL/min. Eleven of them (group A) had an ACCR above 3.5% (control 3% ±1.03%) and all exhibited an average reduction of 32.2%±11.6% in rCcr following one week of gentamicin therapy. In contrast, only one of seven patients (group B) with an initial ACCR below 3.5% had a reduction, albeit transient, in rCcr. During gentamicin therapy, group A patients had a further increase in ACCR which was proportional to the reduction observed in rCcr (r= -.54). Our preliminary data suggest that ACCR may prove a simple and possibly a reliable predictor of kidney function deterioration during gentamicin therapy in patients with rCcr above 30 mL/min: patients with pretherapy ACCR above 3.5% may exhibit a deterioration in the creatinine clearance during the first week of therapy. For patients with pretherapy renal failure (rCcr<30 mL/min) the creatinine levels (but not the ACCR) seem to retain their significance in predicting and monitoring further renal function deterioration during aminoglycoside therapy.

(Arch Intern Med 1988;148:1093-1096)

Author Affiliations
From the Department of Medicine "T" (Drs Aderka, Tene, and Levo) and Biochemistry Laboratories (Dr Graff), Tel-Aviv Medical Center, Ichilov Hospital, and Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel. Dr Aderka is now with the Department of Microbiology, New York University Medical Center.

Footnotes
Accepted for publication Dec 11, 1987.

Reprint requests to Department of Microbiology, MSB 272, New York University Medical Center, 550 First Ave, New York, NY 10016 (Dr Aderka).

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