Introduction: Amphotericin B (AB) is the drug of choice for the treatment of several systemic fungal infections. Despite of its effectiveness and minimum relation to the resistance, AB is toxic to animal cells, in particular to the kidney cells. Objective: To address the aspects of resistance, nephrotoxicity and biomarkers available for the early detection of kidney disease caused by AB. Method: The bibliographic search was performed in online databases. Papers published between 2008-2019, were selected for further analysis and inclusion in the present review. Results: The search resulted in 42 eligible papers which the main findings were: (i) the frequency of resistance to AB appears to be substantial, however, some species should be carefully studied given their diminished susceptibility; (ii) regarding nephrotoxicity, new techniques and methods have promisingly been implemented; and (iii) a novel generation of biomarkers for kidney injury is more specific and sensitive. Conclusion: The adoption of conjugated drug delivery systems is a consistent alternative to minimize nephrotoxicity and fungal resistance. Considering the biomarkers, it is more likely that, instead of a punctual assessment of a single biomarker, a set of biomarkers provides a more thorough comprehension of the aspects related to AB-induced kidney injury. Nonetheless, more clinical studies are necessary for further implementation of such biomarkers in the clinical routine. Keywords: Amphotericin B. Nephrotoxicity. Acute Kidney Injury. Biomarkers.

O aumento gradativo da incidência de infecções fúngicas é resultado de vários fatores e, um deles, é o número crescente de pacientes com imunossupressão severa. Apesar de novos medicamentos estarem sendo introduzidos para minimizar este problema, o desenvolvimento de resistência diante das drogas antifúngicas se tornou evidente, em especial nos pacientes que recebem tratamentos longos, ou que estão recebendo antifúngicos de forma profilática, onde, em ambos os casos, pode haver mudanças na microbiota humana, dando origem a um ambiente favorável às espécies resistentes. As características farmacológicas, a frequência e, em particular, os mecanismos de resistência para atual classe de agentes antifúngicos são debatidos nesta revisão.

Introduction: Amphotericin B (AB) is the drug of choice for the treatment of several systemic fungal infections. Despite of its effectiveness and minimum relation to the resistance, AB is toxic to animal cells, in particular to the kidney cells. Objective: To address the aspects of resistance, nephrotoxicity and biomarkers available for the early detection of kidney disease caused by AB. Method: The bibliographic search was performed in online databases. Papers published between 2008-2019, were selected for further analysis and inclusion in the present review. Results: The search resulted in 42 eligible papers which the main findings were: (i) the frequency of resistance to AB appears to be substantial, however, some species should be carefully studied given their diminished susceptibility; (ii) regarding nephrotoxicity, new techniques and methods have promisingly been implemented; and (iii) a novel generation of biomarkers for kidney injury is more specific and sensitive. Conclusion: The adoption of conjugated drug delivery systems is a consistent alternative to minimize nephrotoxicity and fungal resistance. Considering the biomarkers, it is more likely that, instead of a punctual assessment of a single biomarker, a set of biomarkers provides a more thorough comprehension of the aspects related to AB-induced kidney injury. Nonetheless, more clinical studies are necessary for further implementation of such biomarkers in the clinical routine. Keywords: Amphotericin B. Nephrotoxicity. Acute Kidney Injury. Biomarkers.

O aumento gradativo da incidência de infecções fúngicas é resultado de vários fatores e, um deles, é o número crescente de pacientes com imunossupressão severa. Apesar de novos medicamentos estarem sendo introduzidos para minimizar este problema, o desenvolvimento de resistência diante das drogas antifúngicas se tornou evidente, em especial nos pacientes que recebem tratamentos longos, ou que estão recebendo antifúngicos de forma profilática, onde, em ambos os casos, pode haver mudanças na microbiota humana, dando origem a um ambiente favorável às espécies resistentes. As características farmacológicas, a frequência e, em particular, os mecanismos de resistência para atual classe de agentes antifúngicos são debatidos nesta revisão.