Abstract：
Because of their broad-spectrum bactericidal activity, amoxicillin (AMX) and third-generation cephalosporins (TGC) are widely used for the prophylaxis and treatment of established infections. They are considered relatively safe, but several recent reports have suggested substantial nephrotoxicity, especially with AMX use. Considering the importance of AMX and TGC for clinical practice, we conducted this up-to-date review, using the PubMed database, which focuses specifically on the nephrotoxicity of these molecules. We also briefly review the pharmacology of AMX and TGC. Nephrotoxicity of AMX may be driven by several pathophysiological mechanisms, such as a type IV hypersensitivity reaction, anaphylaxis, or intratubular and/or urinary tract drug precipitation. In this review, we focused on the two main renal adverse effects of AMX, namely acute interstitial nephritis and crystal nephropathy. We summarize the current knowledge in terms of incidence, pathogenesis, factors, clinical features, and diagnosis. The purpose of this review is also to underline the probable underestimation of AMX nephrotoxicity and to educate clinicians about the recent increased incidence and severe renal prognosis associated with crystal nephropathy. We also suggest some key elements on the management of these complications to avoid inappropriate use and to limit the risk of nephrotoxicity. While renal injury appears to be rarer with TGC, several patterns of nephrotoxicity have been reported in the literature, such as nephrolithiasis, immune-mediated hemolytic anemia, or acute interstitial nephropathy, which we detail in the second part of this review.
摘要：
由于其广谱杀菌活性,阿莫西林（AMX）和第三代头孢菌素（TGC）广泛用于预防和治疗已确定的感染。它们被认为是相对安全的，但是最近的一些报道表明有很大的肾毒性，尤其是使用AMX。考虑到AMX和TGC在临床实践中的重要性，我们进行了最新的审查，使用PubMed数据库，特别关注这些分子的肾毒性。我们还简要回顾了AMX和TGC的药理学。AMX的肾毒性可能由几种病理生理机制驱动，如IV型超敏反应，过敏反应，或肾小管内和/或尿路药物沉淀。在这次审查中,我们关注AMX的两个主要肾脏不良反应，即急性间质性肾炎和晶体肾病。我们在发病率方面总结了当前的知识，发病机制，因素，临床特征,和诊断。这篇综述的目的也是强调AMX肾毒性的可能低估，并教育临床医生最近与晶体肾病相关的发病率增加和严重的肾脏预后。我们还提出了处理这些并发症的一些关键要素，以避免不当使用并限制肾毒性的风险。虽然TGC的肾损伤似乎更罕见，文献中已经报道了几种类型的肾毒性，比如肾结石，免疫介导的溶血性贫血，或者急性间质性肾病,我们在这篇综述的第二部分详细介绍了这一点。
