Which antifungal agent should be monitored closely because of potential renal toxicity?

Amphotericin B is known for its potential renal toxicity, which is a significant concern when using this antifungal agent. It can lead to nephrotoxicity by causing damage to the renal tubules, which may result in impaired kidney function. This is especially relevant in patients who are receiving high doses or prolonged therapy. Given its mechanism of action, Amphotericin B binds to ergosterol in fungal cell membranes, leading to cell death, but this binding can also adversely affect the human cells, particularly in the kidneys.

Due to this risk, it is essential to monitor kidney function, typically through serum creatinine levels and electrolyte balances during treatment with Amphotericin B. This proactive approach helps in early detection of any renal impairment, allowing for timely adjustments to therapy if necessary.

In contrast, while Clotrimazole and echinocandins are generally considered to have a much lower risk of renal toxicity, flucytosine also requires monitoring but is more associated with hematologic toxicities than renal issues. Therefore, Amphotericin B is the most critical antifungal agent that necessitates vigilant monitoring for renal complications.