Covid, Mucormycosis & Now Drug-induced Kidney Injury: Expert
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Mehsana resident, 30, has had one of the roughest one-and-a-half months health-wise. He survived a critical Covid-19 attack only to fall prey to mucormycosis. With the severe scarcity of liposomal Amphotericin B, the drug of choice for treating black fungus, the tractor dealer was given lyophilised Amphotericin B, which is very cheap but highly nephrotoxic. As expected, his kidneys were badly impaired as a side-effect of his medicine.

His mucormycosis treatment had to be suspended and was put on dialysis to salvage his kidneys and life. “After five dialysis his kidneys recovered and he was put on oral Posaconazole, the second drug of choice to halt the spread of black fungus. Doctors say kidney complications have prolonged his recovery," said his brother-in-law. He has survived 80% lung involvement and eye removal. Lack of availability of recommended injections has hurt his recovery.

If mucormycosis as an aftermath of Covid-19 infection was not bad enough, many black fungus patients are reporting acute kidney injury (AKI) as a side-effect of treatment of the dreaded fungus. Several city-based hospitals say AKI is reported in 20 to 30% of patients under treatment.

Dr Vineet Mishra, director of IKDRC or Kidney Hospital, said that Amphotericin B is known to be nephrotoxic. “The drug, when taken in lyophilized form, has more impact on kidney functions. While it arrests the growth of fungi, it also damages the kidney tissues. Thus, whenever the medicine is used – as it surely saves lives – it must be done with supervision of a nephrologist,” he said.

~ ‘Lyophilized form very nephro-toxic’

We have so far treated 41 patients of mucormycosis at IKDRC-ITS. Out of total patients, 20 or 50% have reported higher creatinine levels – indicating kidney malfunction or AKI,” said Dr Vivek Kute, professor of nephrology at IKDRC-ITS. The patients included 15 transplant patients.

Lyophilized form is highly nephro-toxic. liposomal Amphotericin B safer choice and globally recommended. Experts said that even today, liposome injections are scarcely made available by the government which controls MM drugs. Dr Rajesh Vishwakarma, director of the department of head & neck surgery at Apollo Hospital, said they are seeing AKI in about 20-30% of the mucormycosis patients.

Dr Umesh Godhani, a city-based nephrologist and transplant physician, said that they have witnessed AKI in about 20% of mucormycosis patients. “Liposomal injections are both scarce and costly. Thus, mostly the patients are administered lyophilized drugs. Thus, when the not-so-healthy patient is administered the drug, we must observe them continuously. In one case a patient needed one dialysis, whereas in a few cases, we discontinued amphotericin for a few days.”

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