Acute kidney injury associated to sulfamethoxazole urine crystal: The importance of clinical suspicion.

Clinical Nephrology. Case Studies Pub Date : 2022-09-23 eCollection Date: 2022-01-01 DOI:10.5414/CNCS110931
Rodrigo A Sepúlveda, Fiorella Anghileri, Juan Pablo Huidobro E, Rodrigo Julio, Eduardo Ávila, Cristián Figueroa
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引用次数: 2

Abstract

Management of acute kidney injury (AKI) associated with drug-induced crystal nephropathy can be difficult, and timely diagnosis is critical to resolve this condition. We present the case of a 55-year-old woman with history of systemic lupus erythematosus (SLE), who, after treatment with trimethoprim/sulfamethoxazole (TMP/SMX) for suspected Pneumocystis jirovecii pneumonia, developed severe AKI. Automated urinary sediment initially reported hematuria, leukocyturia and "uric acid crystals". She did not have allergic symptoms, clinical manifestations of active SLE nor hyperuricemia. AKI persisted despite volume expansion with crystalloids. Due to SMX exposure, it was suspected that "uric acid crystals" could be in reality "SMX crystals", and were a possible cause of crystal nephropathy. TMP/SMX was withheld and urinary alkalization was performed, with subsequent resolution of AKI. SMX urine crystals were posteriorly confirmed by Fourier transform infrared spectroscopy.

Abstract Image

Abstract Image

磺胺甲恶唑尿晶所致急性肾损伤:临床怀疑的重要性。
与药物性结晶肾病相关的急性肾损伤(AKI)的管理可能是困难的,及时诊断是解决这种情况的关键。我们报告了一例55岁的系统性红斑狼疮(SLE)病史的女性,她在接受甲氧苄啶/磺胺甲恶唑(TMP/SMX)治疗疑似乙氏肺囊虫肺炎后,发展为严重的AKI。自动尿液沉淀物最初报告血尿、白细胞尿和“尿酸结晶”。无过敏症状,无活动性SLE临床表现,无高尿酸血症。尽管晶体体积膨胀,AKI仍然存在。由于SMX暴露,怀疑“尿酸结晶”实际上可能是“SMX结晶”,可能是结晶肾病的原因之一。保留TMP/SMX并进行尿碱化,随后AKI得到解决。用傅里叶变换红外光谱对SMX尿液晶体进行后验验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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