Acute renal failure sulfonamides

Drug-induced tubulointerstitial nephritides represent 1-10% of cases of acute renal failure and is characterized by infiltrates of mononuclear cells associated with tubular cell injury. A lot of drugs are incriminated, including antibiotics (P-lactams, sulfonamides, aminoglycosides, quinolones), antiepileptic drugs, diuretics, proton pump inhibitors, foscarnet and non-steroidal anti-inflammatory drugs [73]. Most often, withdrawal of the drug, with or without concomitant administration of steroids improves the renal functions. 

Tubulointerstitial nephritis can be either acute or chronic in nature. Acute interstitial nephritis is characterized by an acute renal interstitial inflammatory response with urinary eosinophils and nonoliguric acute renal failure. The more common drugs that induce acute interstitial nephritis include penicillins, rifampicin, sulfonamides, and cimetadine. Chronic tubulointerstitial nephritis is most commonly associated with the long term use of large amounts of analgesics and antiinflammatory agents (e.g., NSAIDs). 

Penicillin-induced renal toxicity is most commonly seen as allergic acute interstitial nephritis (AIN). Methicillin is the most common penicillin to induce AIN, but the use of penicillin G, ampicillin, am-oxacillin, oxacillin, and carbenicillin also can lead to the development of AIN. Typically, acute renal failure follows 1 or 2 weeks of treatment with fever or rashes sometimes occurring before overt renal dysfunction. Removal of the penicillin generally allows renal function to return to normal within a few days or weeks. AIN can also be induced by certain cephalosporins (e.g., cephalothin, cephalexin, cephradine, cefoxitin, cefotaxime) and non-/i-lactam antimicrobials (e.g., sulfonamides, rifampicin, tetracyclines, erythromycin). 

These compounds were extensively used in the 40 s through the 60 s to treat pulmonary and other systemic infections. Reports of acute renal failure, most secondary to crystalluria were common [1-3]. Rarely, the sulfonamides can cause acute interstitial nephritis, necrotizing arteritis or hemoglobinuric acute renal failure due to massive acute hemolytic anemia [4, 6]. 

Sulfonamides Unknown Acute renal failure caused by crystal deposition. 

The development of an acute interstitial inflammatory reaction in the kidney related to the administration of certain classes of drugs and leading to renal failure has been recognized for almost a century [42]. Antibiotics, in particular the sulfonamides [43] and semisynthetic penicillins [44, 45], were recognized as etio-logically associated in many instances. A retrospective review of 1068 kidney biopsies from 1%8 to 1997 by Schwarz et al. yielded acute interstitial nephritis in 6.5% of cases. In the majority of instances (85%) acute interstitial nephritis was drug related. Diuretics were implicated in 7.8 % of these cases [46]. Lyons et al. noted that four patients with proliferative glomerulonephritis and nephrotic syndrome treated with sulfonamide-derivative diuretics (furosemide or thiazides) developed severe renal failure, which reversed when the diuretic was withdrawn and prednisone was adminis-... 

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