Biomarcadores de nefrotoxicidade e hepatotoxicidade induzidas por antimicrobianos: da lesão ao monitoramento clínico

• DOI: https://doi.org/10.22533/at.ed.8089282604057

• Palavras-chave: Antimicrobianos; Biomarcadores; Hepatotoxicidade; Nefrotoxicidade; Toxicidade medicamentosa

• Keywords: Antimicrobials; Biomarkers; Hepatotoxicity; Nephrotoxicity; Drug toxicity.

• Abstract: Introduction: Prolonged use of antimicrobials exposes the kidneys and liver to significant risks of organ toxicity. A critical aspect is their capacity to develop subclinically, with ongoing structural damage before classic biomarkers show detectable changes, making systematic laboratory monitoring a clinical necessity. Methodology: Narrative review with a qualitative approach. The search was conducted in PubMed, covering publications from the last five years (2022–2026), including original studies and reviews published in Portuguese, English, or Spanish. Results and Discussion: Five patterns of organ injury were identified. In the kidney, direct tubular toxicity is associated with early elevation of KIM-1, NGAL, NAG, and clusterin, preceding rises in serum creatinine. Immune-mediated interstitial inflammatory toxicity has urinary CXCL9 as its most specific biomarker. In the liver, direct hepatocellular damage and immune-mediated cholestatic injury were identified. Across both organs, classic biomarkers demonstrated late elevation relative to the onset of cellular injury, whereas emerging markers such as KIM-1, clusterin, GLDH, and miR-122 extend the window for early detection. Conclusion: Integrating early structural markers into the clinical monitoring of patients on prolonged antimicrobial therapy represents an unmet need in current practice and a priority direction for future research.