Aminoglycoside Nephrotoxicity Using 99mTc-DTPA Renal Scan

Song, Sang Heun; Park, Sung Min; Sung, Eun Young; Lee, Dong Won; Lee, Soo Bong; Lee, Woo Chul; Jung, Hyun Chul; Lee, Chang Won; Kwak, Ihm Soo; Rha, Ha Yeon

Abstract

Aminoglycoside has a broad-spectrum bactericidal activity and especially excellent effect on gram negative bacteria. But, its harmful effect is existed about kidney and ear. Among these, many studies were done about aminoglycoside nephrotoxicity. Until now, many authors have been reported its incidence was 4.45-45%. We needed parameters monitoring about nephrotoxicity. So, our study was done using 99mTc-DTPA renal scan to evaluate nephrotoxicity. We enrolled forty patients who admitted due to infection. 32 patients received Netilmicin and 8 patients Isepamicin. Mean duration and dosage were 8 days, 200mg daily. We accomplished 99mTc-DTPA renal scan, 24hr urine study and blood sampling before starting antibiotics. After mean 8 days, same procedure was repeated. Aminoglycoside nephrotoxicity(defined as 50% GFR reduction) was presented in only one patient. She didn't have risky factor, such as hepatic dysfunction, hypotension, previous renal problem. However, duration was longer than other patients(13 days). GFR was fallen by 25-50% in 6 patients. This finding represent nephrotoxic effects of aminoglycoside indirectly. Above 6 patients had not any characteristics compared to other 33 patients. In addition to renal scan, sodium excretion was increased compared to pre-antibiotics, and glomerular filtration rate using 99mTc-DTPA renal scan was positively correlated with 24hr urine creatinine clearance, GFR by Cockcroft & Gault equation. I conclude that aminoglycoside has nephrotoxic effect when used for longer period. Thus, I suggest that DTPA renal scan including other many renal monitoring method has usefulness in revealing aminoglycoside nephrotoxicity.