Which antifungal agent is MOST likely to cause renal insufficiency?

Amphotericin B is known for its potential nephrotoxicity, making it the antifungal agent most likely to cause renal insufficiency. This medication works by binding to ergosterol in fungal cell membranes, leading to cell death. However, it can also bind to cholesterol in human cells, particularly those in the kidneys, resulting in damage to renal tubules and a decrease in renal function.

The risk of renal impairment is a significant concern when using Amphotericin B, especially with prolonged use or higher doses. Clinicians closely monitor kidney function in patients receiving this drug and may implement strategies to mitigate its nephrotoxic effects, such as using liposomal formulations which can reduce toxicity while retaining antifungal efficacy.

In contrast, Fluconazole, Itraconazole, and Posaconazole are generally better tolerated regarding renal function. While they can still affect renal parameters under certain conditions, they do not have the same established risk for direct renal damage as Amphotericin B has. Thus, when considering antifungal therapies, Amphotericin B’s side effect profile distinctly includes a higher likelihood of causing renal insufficiency.