Dokaj pogost zaplet uporabe aminoglikozidnih antibiotikov je renalna akutna ledvična okvara (ALO). Dejavniki tveganja so visoka starost bolnika, ženski spol, pridružene bolezni, zmanjšan efektivni ...arterijski volumen, sepsa, sočasna druga zdravila, tip aminoglikozidnega antibiotika, zvišana koncentracija aminoglikozidnega antibiotika v plazmi, način doziranja in podaljšano trajanje zdravljenja z aminoglikozidnimi antibiotiki. ALO se večinoma pojavi po 5-7 dneh jemanja, večinoma je neoligurična. Ob ALO antibiotik prekinemo, zdravljenje je le simptomatsko. Večinoma pride do povrnitve ledvične funkcije, kreatinin upade do začetnih vrednosti po približno treh tednih po prekinitvi antibiotične terapije. Prikazani primer obravnava ALO v sklopu uporabe gentamicina zaradi septičnega artritisa desnega kolena.
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