IN THE NEWS ---> Vancomycin and the kidney

A recent review in Kidney International May 2010 issue talks about the recent changes in vancomycin dosing and how it is affecting the renal community. Due to increase in vancomycin resistance and treatment failure, the infectious disease societies have advocated new guidelines to keep levels of the drug at 15-20 from the older 10-14 ranges.  The articles reviews that these high trough levels might be associated with nephrotoxicity.
Just in the recent 2010 NKF spring meetings, I saw a poster presentation that talked about a series of vancomycin induced ATN toxicity likely as a result of this high trough range.  The risk is incremental and the higher the trough levels and longer the duration of vancomycin use puts you at a higher risk.  This paper suggests that perhaps patients with already existing renal disease as well as patients with acute renal failure and critically ill might be more prone to get worsening renal damage.
A nice table in the paper reviews the studies that showed these nephrotoxicities. How this will affect the ESRD patients is still unclear.

image source: www.3dchem.com