This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 17. Genitourinary Disorders Chapter 226. The effects of some antibiotics on various portions of the nephron are shown in Fig.
Protein binding substantially affects pharmacokinetics and cell toxicity in many organs.
In renal failure, protein binding of acidic drugs is reduced because of loss of plasma protein. Aminoglycosides also increase urinary enzyme and protein levels and decrease creatinine clearance. Unless toxicity is severe, nonoliguric renal failure usually results. Because these drugs accumulate, toxicity may be delayed or may occur early in a repeat course of therapy. Outdated tetracycline may produce a Fanconi-like syndrome.