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RA Giuliano, GA Verpooten, L Verbist, RP Wedeen and ME De Broe
The renal cortical uptake kinetics of four aminoglycosides were studied in vivo. Gentamicin, netilmicin, tobramycin or amikacin were administered to rats by continuous infusion over 6 hr achieving constant serum levels ranging from 0.2 to 100 micrograms/ml. Renal cortical concentrations at the end of the infusion were plotted against the steady-state serum levels. Steady-state elevations of serum gentamicin and netilmicin were associated with nonlinear increases in cortical levels, suggesting saturable uptake. Analysis of the data using Michaelis-Menten kinetics indicates that the apparent Km for gentamicin and netilmicin were 15.01 and 23.84 micrograms/ml and Vmax 149.83 and 178.36 micrograms/g of cortex per hr, respectively. The "initial" rate of uptake (at serum levels below 15 micrograms/ml) was highest for gentamicin. The cortical uptake of tobramycin was linearly related to elevations in serum levels [cortex concentration (conc) = 9.24 + 1.40 serum conc]. The initial rate of tobramycin uptake was considerably lower than that for gentamicin and netilmicin. For amikacin, the initial rate of uptake followed Michaelis Menten kinetics and the second phase of the titration curve was linear. The equation for total amikacin uptake was: cortex conc = 12.98 + 1.71 serum conc. Aminoglycosides exhibit differing kinetics for renal cortical uptake in the rat during constant infusions. These results indicate that more than one mechanism probably mediates the uptake of each aminoglycoside. Depending on which mechanism predominates, the kinetic pattern may be saturable, linear or mixed.
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