Introduction
Nephrotoxicity is defined as the rapid deterioration of renal function due to the toxic effects of drugs or chemicals. It comes in various forms, and some drugs can affect kidney function in more than one way. Nephrotoxins are substances that exhibit nephrotoxicity. Vancomycin is used to treat colitis (inflammation of the intestine caused by certain bacteria) that can occur after antibiotic treatment. Vancomycin belongs to a class of drugs called glycopeptide antibiotics. It works by killing intestinal bacteria. Vancomycin does not kill bacteria or treat infections in other parts of the body when taken by mouth. Antibiotics like Vancomycin do not work against colds, flu, and other viral infections. Taking antibiotics when they are not required increases the risk of later infections that are resistant to antibiotic treatment.
What Is Vancomycin-Associated Nephrotoxicity?
Vancomycin is said to have oxidative effects on the proximal tubular cells of the kidney. Vancomycin can alter the function of the powerhouse of the cell which is mitochondria and induce dose-dependent growth of proximal tubular cells (PTCs) of the kidney. Vancomycin has been shown to have nephrotoxic effects, which can lead to acute kidney injury (AKI). This is caused as the drug impedes blood flow and oxygen from reaching the kidneys.
How Does Vancomycin Cause Nephrotoxicity?
The mechanism by which the kidney metabolizes and excretes various drugs and toxins is a major factor in drug nephrotoxicity. The high rate of delivery of drugs and toxins to the kidney as a result of high renal blood flow, which accounts for approximately 25 % of cardiac output, exposes the kidney to significant drug concentrations of the drug. Furthermore, many tubular cells, especially those in Henle's loop (blood vessel where nutrients are reabsorbed in the kidney), reside in a relatively hypoxic environment due to the high metabolic demands associated with the active transport of solutes through Na+-K+-ATPase-mediated transport. Excessive cellular load on these cells in this hypoxic environment increases the risk of nephrotoxicity-related damage. Due to the high concentration of the kidney, certain drugs, and their metabolites occur in high concentrations in the kidney, and through direct toxicity, decreased prostaglandin (group of physiologically active lipid compounds called eicosanoids) and increased thromboxane (member of lipid family) production lead to renal damage and causes injury due to reduced blood flow.
What Are the Risk Factors of Vancomycin-Associated Nephrotoxicity?
Vancomycin-induced nephrotoxicity is increasingly recognized as a significant cause of renal diseases such as acute kidney injury (AKI) and chronic kidney disease (CKD). Nephrotoxicity has a wide range that reflects damage to different nephron segments based on individual drug mechanisms. Both glomerular and tubular damage are recognized targets for drug toxicity and can lead to acute or chronic functional alterations.
Listed below are some risk factors that may cause Vancomycin-induced nephrotoxicity. These are patient-based factors:
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Age- Elderly patients have an increased risk of nephrotoxicity.
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Sex- Males are more likely to develop nephrotoxicity than females.
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Race- People of some races are genetically more susceptible to nephrotoxicity than other races.
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Comorbid Conditions Like Diabetes and Hypertension- People with other ongoing health conditions are more likely to have a drug-induced nephrotoxic reaction.
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Duration of Treatment- Prolong duration of treatment may lead to nephrotoxicity in people.
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Other Drug Interactions- Giving potentially nephrotoxic drugs along with other nephrotoxic drugs can increase the incidence of nephrotoxicity.
What Are the Symptoms of Vancomycin-Associated Nephrotoxicity?
Nephrotoxicity means that the kidneys are no longer functioning adequately to perform these tasks, resulting in other health problems. The following symptoms show the onset of nephrotoxicity:
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Swelling, usually in the leg, foot, or ankle.
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Having a headache.
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Feeling itchy.
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Feeling tired during the day and unable to sleep at night.
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Nausea, loss of taste, hunger, or weight loss.
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Little or no urine output.
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Have muscle spasms, weakness, or numbness.
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Pain, stiffness, or fluid accumulation in the joints.
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Feeling confused, having trouble concentrating, or having memory problems.
What Are the Possible Complications of Vancomycin-Associated Nephrotoxicity?
The possible complications of Vancomycin-associated nephrotoxicity include
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Tumor Lysis Syndrome- When many cancer cells die within a short period, releasing their contents into the blood.
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Paraneoplastic Glomerulonephritis- Malignancy that is often mistaken for glomerulonephritis.
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Obstructive Uropathy- When urine is not able to drain through the urinary tract.
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Renal Failure- When kidneys lose their filtering abilities.
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Electrolyte Imbalance- When there are elevated or low levels of certain minerals in the body.
When to Get Help?
Seek emergency medical help in the following cases:
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Decreased urine output.
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Fluid retention that causes swelling of the feet, ankles, or feet.
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Difficulty breathing.
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Malaise.
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Confusion.
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Nausea.
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Weakness.
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Irregular heartbeat.
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Chest pain or pressure.
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Seizures or comas in severe cases.
How Is Vancomycin-Associated Nephrotoxicity Diagnosed?
If signs and symptoms suggest acute kidney failure, the doctor may recommend certain tests and procedures to confirm the diagnosis. This includes the following:
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Urine Volume Measurement- Measuring urine output over 24 hours can help doctors identify the cause of kidney failure.
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Urinalysis- Analysis of a urine sample (urinalysis) may reveal abnormalities that indicate kidney failure.
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Blood Test- Blood tests may show rapidly elevated urea and creatinine levels, two substances used to measure kidney function.
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Imaging Test- Imaging tests, such as ultrasound and computed tomography, help doctors see the kidneys.
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Kidney Biopsy- In some circumstances, doctors may recommend a kidney biopsy to obtain a small sample of kidney tissue for laboratory tests. A doctor inserts a needle through the skin into the kidney and takes a sample.
How Is Vancomycin-Associated Nephrotoxicity Treated?
To treat Vancomycin-Induced nephrotoxicity, doctors work to prevent complications and give the kidneys time to heal. Treatments that can help prevent complications include:
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A Treatment That Balances the Amount of Water in the Blood- If acute renal failure is caused by a lack of water in the blood, the doctors may recommend intravenous (IV) fluids. Acute kidney failure can also cause excess fluid in the body, causing swelling of the arms and legs. In such cases, doctors recommend drugs (diuretics) to help the body rid the body of excess water.
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Drugs That Controls Blood Potassium Levels- If the kidneys are not properly filtering potassium from the blood, the doctor may prescribe calcium, glucose, or sodium polystyrene sulfonate to prevent high levels of potassium from building up in the blood. Too much potassium in the blood can cause dangerous arrhythmias (arrhythmias) and muscle weakness.
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Drugs to Restore Blood Calcium Levels- If the blood calcium level drops too low, the doctor may recommend a calcium infusion.
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Dialysis to Remove Toxins From the Blood- Temporary hemodialysis (often simply called dialysis) may be necessary if toxins build up in the blood. This is to remove toxins and excess water from the body while the kidneys heal. Dialysis also helps remove excess potassium from the body. During dialysis, a machine pumps blood from the body through an artificial kidney (dialyzer) that filters waste products. The blood is then returned to the body.
How Can Vancomycin-Associated Nephrotoxicity Be Prevented?
Vancomycin-associated nephrotoxicity can be prevented by the following method:
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Avoid taking the drug for a long duration of time.
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Avoid this drug when suffering from any renal ailment.
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Avoid this drug in heavy dosage.
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Avoid this drug in the case of the elderly population.
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Avoid taking the drug with any other potentially nephrotoxic drug.
Conclusion
Vancomycin is a tricyclic glycopeptide antibiotic that is derived from the organism Streptococcus orientalis. Vancomycin is used for treating and preventing various bacterial infections caused by gram-positive bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA). It is nephrotoxic in nature and can harm the kidneys. Medication should be taken under supervision and not taken for an extended period.
