Fluconazole-Associated Acute Kidney Injury
Fluconazole can be associated with acute kidney injury (AKI), including acute renal failure reported in postmarketing experience. [1] Fluconazole is primarily cleared by renal excretion, and reduced renal clearance increases exposure, which increases risk for renal toxicity in vulnerable patients. [1]
Evidence Linking Fluconazole to AKI
Postmarketing experience reports spontaneous cases of acute renal failure that were more frequent in patients aged 65 years or older than in patients aged 12 to 65 years. [1] A case report described acute kidney injury in a patient with fluconazole toxicity. [2]
Drug Disposition and Renal Clearance
Fluconazole clearance is primarily renal, with approximately 80% of the administered dose appearing in urine as unchanged drug. [1] Dose adjustment based on creatinine clearance is recommended because decreased renal function is more common in older adults and fluconazole exposure is increased. [1]
Clinical Circumstances Increasing AKI Risk
AKI risk is increased when fluconazole exposure is elevated from impaired kidney function, leading to higher systemic concentrations. [1] AKI risk is increased when fluconazole is used with other nephrotoxic drugs or when concomitant immunosuppressants requiring close renal monitoring are used, given fluconazole’s potential to increase levels of coadministered drugs associated with nephrotoxicity. [2]
Recognition and Monitoring
Serum creatinine and renal function monitoring is recommended during fluconazole therapy to support dose adjustment and early detection of renal deterioration. [1]
Management of Suspected Fluconazole-Associated AKI
Fluconazole should be discontinued when drug-induced AKI is suspected, with supportive care directed to the AKI etiology. [2] In overdose or severe toxicity with renal impairment, hemodialysis can reduce plasma fluconazole levels by approximately 50%, which supports clearance when clinically appropriate. [1]
Common Pitfalls to Avoid
Failure to adjust fluconazole dose for creatinine clearance in patients with reduced renal function increases the likelihood of excess drug exposure and renal adverse effects. [1] Failure to monitor renal function during fluconazole therapy delays detection of AKI and delays dose correction. [1]
Practical Conclusion
Fluconazole can cause AKI, with acute renal failure reported in postmarketing experience and AKI reported in clinical case descriptions. [1] [2]