What Nephrotoxic Antibiotic are YOU? #NephMadness #IDRegion

Take the quiz and find out! Then fill out your bracket for NephMadness 2015!

Chi Chu
Created By Chi Chu
On Mar 9, 2015

Do you come from a big family?

How young are you?

Are you popular?

Do you sometimes feel like you live in the hospital?

Do people consider you "generally well tolerated"?

Trimethoprim-Sulfamethoxazole

Trimethoprim-Sulfamethoxazole

You are usually Bactrim, but sometimes Septra and in some places co-trimoxazole. You are an occasional cause of acute interstitial nephritis, but you also have some other renal effects of interest. You block proximal tubular secretion of creatinine leading to an artificial rise in serum creatinine that does not truly represent decreased GFR. Your trimethoprim moiety has a triamterene-like effect (like that mnemonic?), blocking distal sodium reabsorption via ENac channels, leading to potassium sparing that can be responsible for hyperkalemia, particularly in at-risk patients such as those with CKD, and perhaps those on ACEi therapy.

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Amphotericin B

Amphotericin B

You are amphotericin B. You have a toxic disposition, and in addition to renal failure can be responsible for liver failure and bone marrow toxicity. You have so many adverse effects that the medical students even have a special mnemonic for you, dubbing you "ampho-terrible" just to help them remember all the badness you can do. But hey, better to be feared than to be forgotten, right? Your liposomal preparation has been associated with decreased toxicity, so there's that.

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Vancomycin

Vancomycin

You are vancomycin. You are practically a staple of admission orders after "Vitals per unit protocol" and "BMP daily in A.M.". You started off a bit rocky as "Mississippi Mud", when impurities made you especially nephrotoxic, but those days are long gone now and your station is secure as the go-to agent against MRSA, both real and imaginary. Because you're so useful these days a lot of people tend to overlook your flaws, including your bad habit of causing ATN via oxidative damage. Some say that higher troughs are associated with AKI but you might argue that the latter caused the former. It's a chicken-egg situation, and you'd like to keep it that way.

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Piperacillin-Tazobactam

Piperacillin-Tazobactam

You are piperacillin-tazobactam, or zosyn for short. You ride with vancomycin so often that when acute kidney injury occurs you let your buddy take the fall, and no one really looks at you. But you're actually responsible for AKI by a number of mechanisms including direct acute tubular necrosis, acute interstitial nephritis, and potentiating vancomycin nephrotoxicity. You dirty little devil. You do get the blame when it comes to thrombocytopenia in the ICU, but that's just your way of reminding the ICU team it's time to de-escalate antibiotic therapy: a public service, really.

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Gentamicin

Gentamicin

You are gentamicin. You've fallen out of favor in recent times because of an established reputation for nephrotoxicity (via ATN) and ototoxicity. No one even thinks of you these days anymore and you get sad sometimes, but you have managed to retain good anti-pseudomonal activity, which is probably your saving grace and practically the only thing you're used for systemically. On the plus side, you do feature prominently as eyedrops and eardrops these days. Kidney saving strategies include once-daily dosing and choosing your less nephrotoxic relatives, like amikacin and tobramycin, whenever possible.

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Acyclovir

Acyclovir

You are acyclovir. The go-to anti-HSV agent for years, you inflict renal injury by crystal-induced nephropathy. Particularly at risk are those getting IV acyclovir. But you might actually be okay in renally-adjusted doses, taken with plenty of hydration. In addition, there's data about acyclovir causing neurologic toxicity as well - but you'd say just chock it up to the presumed encephalitis you're supposedly empirically treating, and call it a day.

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