Acute renal failure due to sulphadiazine crystalluria in AIDS patients

Abstract

SummaryWe report two AIDS patients who developed acute renal failure while receiving sulphadiazine for cerebral toxoplasmosis. Renal ultrasound revealed diffuse bilateral echogenic shadowing material. 'Sheaves ofwheat' crystals, typical of sulphadiazine crystalluria, were present in the urine. One patient required a percutaneous nephrostomy. Hydration and urine alkalinisation resulted in rapid improvement of renal function and ultrasonographic findings. Sulphadiazine-induced crystailuria and acute renal failure is increasingly frequent. Awareness of its existence may lead to prevention and early conservative treatment.

Complete resolution of sulphadiazine-induced nephrolithiasis using urinary alkalinisation

“…Hyperhydration, urinary alkalinisation and cessation of sulphadiazine therapy have been described as prophylaxis for future episodes, as well as in the short- to medium-term management in terms of reducing symptoms and stone burden. 3,5,6,13,14 Due to the small number of cases, there is no clear consensus in the literature about the duration of these treatments. Clindamycin is often suggested as an alternative antibacterial agent for management of ongoing toxoplasmosis infection.…”

Drug-induced Kidney Disease – Pathology and Current Concepts

“…The kidneys display linear yellow striations in the medulla and papillae, corresponding to the distribution of the collecting ducts in which the crystals have precipitated. 111 Sulfadiazine, 112 indinavir 113,114 and acyclovir 115 have all been associated with tubular crystallopathy, urolithiasis and interstitial nephritis. The crystals, like those of uric acid, often dissolve and form empty acicular spaces engulfed by histiocytes (Fig.…”

Nephrotoxicity

“…In addition to various antiretroviral drugs, which may themselves interact, HIV patients are frequently exposed to other potentially nephrotoxic drugs, including acyclovir, aminoglycoside antibiotics, amphotericin, foscarnet, pentamidine, sulfadiazine, and trimethoprim-sulfamethoxazole [51]. In addition to various antiretroviral drugs, which may themselves interact, HIV patients are frequently exposed to other potentially nephrotoxic drugs, including acyclovir, aminoglycoside antibiotics, amphotericin, foscarnet, pentamidine, sulfadiazine, and trimethoprim-sulfamethoxazole [51].…”