A Possible Mechanism for Increased Susceptibility to Aminoglycoside Nephrotoxicity in Chronic Renal Disease

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Abstract
To the Editor: It is generally accepted that patients with preexisting renal insufficiency are more susceptible to aminoglycoside nephrotoxicity than patients with normal renal function.1 2 3 With advancing chronic renal disease and an ever-decreasing whole-kidney glomerular filtration rate (GFR), there is a continually diminishing population of functional nephrons, which must increase their individual excretory capacity to maintain fluid and electrolyte homeostasis.4 5 6 As renal disease progresses and the functioning nephron population decreases, the residual nephrons increase their individual excretory capacity to maintain external solute and fluid balance. The greater the decrease in GFR, the greater the excretory response per residual nephron. The . . .

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