The mechanism of amphotericin-induced renal failure is felt to be acute tubular necrosis (ATN); the drug binds to sterols in cell membranes, creating pores that destroy the plasma membrane–both the fungal plasma membrane as well as renal epithelial cell plasma membranes, which is felt to be the mechanism of its nephroxocity. Amphotericin-induced renal failure is dose-related and rarely develops unless the total dose exceeds 2gm.
In addition to ATN, amphotericin has other notable renal side effects as well: the drug can cause distal (Type I) renal tubular acidosis, nephrogenic diabetes insipidus, and renal potassium and magnesium wasting as well.
