Gentamisine Bağlı Nefrotoksisiteyi Önleme Potansiyeli Olan Tedavilerin Gözden Geçirilmesi

Abstract

Aminoglikozitler, düşük maliyetleri, yüksek etkililikleri ve diğer antibiyotiklere kıyasla nispeten düşük bakteri direncine sahip olmaları nedeniyle dünya çapında sıklıkla kullanılan antibiyotikler arasındadır. Yaygın kullanımlarına ve olumlu etkilerine karşın böbrek proksimal tübülüs epitel hücrelerinde birikerek toksisite gelişimine neden olabilme ihtimalleri bu ilaçların rahatça kullanımını sınırlamaktadır. Aminoglikozitlere bağlı oluşabilecek nefrotoksisiteye karşı koruyucu olması ümidiyle deney hayvanlarında birçok farmakolojik ajan denenmiş olmasına rağmen hali hazırda rutin olarak kullanılan bir nefroprotektan ajan bulunamamıştır. Çalışmaların çoğunda nefrotoksisite oluşturmak için aminoglikozitlerin prototipi olarak gentamisin kullanılmıştır. Muhtemel koruyucu etkinliği değerlendirmek için antioksidan indeksler, inflamatuar yanıtlar ve apoptotik belirteçler değerlendirilmiştir. Doğal ürünler, vitamin ve mineraller, hormonlar ve birçok konvansiyonel ilaç nefrotoksisiteyi önlemek için potansiyel etkiler göstermiştir. Ayrıca, sadece kullanılan ajan değil uygulama yolu ve süresine göre de sonuçların değişebildiği görülmektedir. Konuyla ilgili çok sayıda çalışma olmasına rağmen, net sonuçlar elde etmek için daha fazla araştırma yapılması gerekliliği açıktır. Bu çalışmada, nefrotoksisite oluşturma potansiyeli taşıyan aminoglikozitlerden gentamisin kullanılarak kemirgenler üzerinde son on yılda yapılan klinik öncesi araştırmalar gözden geçirilmiştir. Bu konuda yapılan çalışmalarda tedavi ve koruma amacı ile kullanılan ajanlar, doğal ürünler, mineral ve vitaminler, hormonlar, kimyasal ajanlar ve konvansiyonel ilaçlar olarak gruplandırılmış ve kullanılan ajanların ne kadar geniş bir spektrumda olduğu gösterilmeye çalışılmıştır. Her bir çalışmada değerlendirmede kullanılan parametreler konusunda bilgi verilerek ileride yapılacak araştırmalarda çalışmaların karşılaştırılabilir olması için standardizasyona katkıda bulunmak amaçlanmıştır.

Keywords

• Aminoglikozit
• gentamisin
• nefrotoksisite
• oksidatif stres

Review of Treatments with Gentamicin-Induced Nephrotoxicity Prevention Potential

Abstract

Aminoglycosides are among the antibiotics frequently used worldwide due to their low cost, high efficacy, and relatively low bacterial resistance compared to other antibiotics. Despite their widespread use and positive effects, the possibility of accumulating in the renal proximal tubule epithelial cells and causing toxicity limits the comfortable use of these drugs. Although many pharmacological agents have been tried in experimental animals in the hope of being protective against nephrotoxicity that may occur due to aminoglycosides, no nephroprotectant agent that is used routinely has been found yet. Gentamicin has been used as a prototype of aminoglycosides to induce nephrotoxicity in most studies. Antioxidant indices, inflammatory responses, and apoptotic markers were evaluated to assess possible protective efficacy. Natural products, vitamins and minerals, hormones, and many conventional drugs have shown potential effects to prevent nephrotoxicity. In addition, it is seen that the results may vary not only according to the agent used but also the method and duration of administration. Although there are many studies on the subject, it is clear that more research is needed to obtain clear results. In this study, preclinical studies conducted in rodents over the last ten years using gentamicin, an aminoglycoside with the potential to cause nephrotoxicity, were reviewed. In studies on this subject, agents used for treatment and protection were grouped as natural products, minerals and vitamins, hormones, chemical agents and conventional drugs, and it was tried to show how wide a spectrum the agents used were. By providing information about the parameters used in the evaluation in each study, it is aimed to contribute to standardization so that studies can be compared in future studies.

Keywords

• Aminoglycoside
• gentamicin
• nephrotoxicity
• oxidative stress

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