Acute renal failure acetazolamide

Acute renal failure, e.g. cuninoglycosides, cisplatin Nephrotic syndrome, e.g. penicillamine, gold, cap-topril (only at higher doses than now recommended) Chronic renal failure, e.g. NSAIDs Functional impairment, i.e. reduced ability to dilute and concentrate urine (lithium), potassium loss in urine (loop diuretics), acid-base imbalance (acetazolamide). 

The administration of acetazolamide has been reported to be associated with hematuria and acute renal failure [70-76]. In each of these patients, intratubular obstruction caused by crystal deposition, stone formation, and the presence of blood clots was either found or suspected. Relief of the obstruction and discontinuation of the drug resulted in the reversal of the renal failure. Volume expansion and mechanical relief of obstruction have been advocated in the treatment of this condition. However, the administration of sodium bicarbonate is controversial, since it may predispose to the development of calcium phosphate stones [77, 78]. 

Higenbottam T, Ogg CS, Saxton HM. Acute renal failure from the use of acetazolamide (Diamox). Postgrad Med J 1978 54 127-128. 

A case of acute renal failure has been reported in a woman who underwent retinal sui eiy, which occurred after the postoperative use of a total of 2 g of acetazolamide, 80 g of mannitol and 700 mg of ketoprofen. There appear to be no other similar case reports, but note that loop diuretics , (p.949) are known to increase the risk of NSAID-induced acute renal failure. 

Causes of hypocalcemia include hypoparathyroidism, hypomagnesemia, alcoholism, hyperphosphatemia, blood product infusion (due to chelation by the citrate buffers), chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, and hypoalbuminemia. Medications that cause hypocalcemia include phosphate replacement products, loop diuretics, phenytoin (Dilantin, available as generic), pheno-barbital (available as generic), corticosteroids, aminoglycoside antibiotics, and acetazolamide (available as generic).34,39,42... 

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