Sulfadiazine-Induced Obstructive Nephropathy Presenting with Upper Urinary Tract Extravasation

Abstract

Background: Obstructive nephropathy is an uncommon side effect of sulfadiazine, which is used for the treatment of toxoplasmosis. We present a case of acute renal colic and urine extravasation of a patient shortly after she was started on this medication.Case Presentation: A 31-year-old female presented with acute renal colic 2 weeks after starting treatment with sulfadiazine and pyrimethamine for ocular toxoplasmosis.Results: A noncontrast computed tomography revealed left hydronephrosis and fluid located around the kidney and in the left gutter. There were no urinary stones. Administration of intravenous contrast revealed significant urine extravasation at the level of the ureteropelvic junction. Intravenous contrast injection confirmed that the extravasation consisted of urine leakage at the ureteropelvic junction. Her clinical condition improved with the insertion of an internal stent, which was left in place for 4 weeks. A retrograde pyelography performed at the time of the internal stent removal ruled out persistent extravasation and filling defects in the left upper urinary tract. Considering the clinical circumstances and the imaging results, it appears that this is a first reported case of sulfadiazine-induced obstructive uropathy associated with urine extravasation.Conclusion: Although rare, obstructive uropathy related to sulfadiazine medication should be promptly suspected, diagnosed, and treated. Patients should be instructed to substantially increase their liquid intake while on that medication.

Renal Failure Due to Sulfadiazine Induced Calculi: Case Report and Literature Review

“…Allinson et al, and Kabha et al, reported cases of patients in whom bilateral nephrostomy and double J stent were used, respectively, for treating ureteral obstructions secondary to sulfadiazine-induced stones. 5,6 The present report demonstrates the case of a patient who under sulfadiazine, treatment for toxoplasmosis developed ureteral calculi and renal insufficiency, due to deposits of sulfa crystals in the renal tubules probably causing an acute interstitial nephritis (NIA). That is a cause of acute renal failure which can be initiated by medications, infections, neoplasms among others.…”

Detección temprana de cristales de sulfadiazina en un paciente VIH positivo con toxoplasmosis

“…En el caso presentado, gracias a la detección precoz de la cristaluria no se objetivó daño renal, pero sí empezaba a presentar una proteinuria subyacente que podría haber derivado en una enfermedad renal aguda inducida por cristales. De hecho, para evitar el daño renal, la mayoría de los autores coinciden en la hiperhidratación del paciente y en la alcalinización urinaria hasta un pH mayor de 7,15 (10). En ocasiones puede ser necesario interrumpir el tratamiento y sustituirlo por Cotrimoxazol® como tratamiento de segunda línea (10).…”

“…De hecho, para evitar el daño renal, la mayoría de los autores coinciden en la hiperhidratación del paciente y en la alcalinización urinaria hasta un pH mayor de 7,15 (10). En ocasiones puede ser necesario interrumpir el tratamiento y sustituirlo por Cotrimoxazol® como tratamiento de segunda línea (10). Una vez que se corrige el grado de hidratación y desaparece la cristaluria no está contraindicado retomar la terapia con sulfadiazina (Fig.…”

Curcumin Clubbed Preventive for Renal Damage

“…Some examinations indicated reduction in renal function in sulfa-treated patients. Sulfa-induced renal damage has typically been introduced as interstitial nephritis, glomerulonephritis, nephritic syndrome and acute renal failure [2]. A Dihydropteroate synthetase enzyme that is responsible for folic acid (FA) production has been confirmed by structural activity relationship (SAR) of sulfanilamide.…”