Interstitial nephritis diuretics

Maxzide Maxzide-25 Anti hypertensive Diuretic Tab Triamterene 75 mg. hydrochlorothiazide 50 mg Tab Triamterene 37.5 mg. hydrochbrothiazide 25 mg 1 tab qd jaundice, pancreatitis, interstitial nephritis, renal stones. 1-2 tab qd... 

All loop diuretics, with the exception of ethacrynic acid, are sulfonamides. Therefore, skin rash, eosinophilia, and less often, interstitial nephritis are occasional adverse effects of these drugs. This toxicity usually resolves rapidly after drug withdrawal. Allergic reactions are much less common with ethacrynic acid. 

Uses Infxns of resp tract, skin/soft tissue, scarlet fever, syphilis Action Bactericidal X cell wall synth Dose Adults. 0.6—4.8 million Units/d in - doses ql2-24h give probenecid at least 30 min prior to PCN to prolong action Peds. 25,000-50,000 Units/kg/d EM - daily-bid Caution [B, M] Contra Allergy Disp Inj SE Pain at inj site, interstitial nephritis, anaphylaxis Interactions T Effects W/ probenecid T penicillin 1/2-life W/ ASA, furosemide, indomethacin, sulfonamides, thiazide diuretics T risk of bleeding W/ anticoagulants X effects W/ chloramphenicol, macrolides, tetracyclines X effects OF OCPs EMS See Penicillin G, Aqueous OD See Penicillin G, Aqueous... 

A series of 11 spontaneously reported cases in which renal impairment was associated with the use of nimesulide has been described (17). The adverse events were represented by acute renal insufficiency n — 2), acute deterioration of chronic renal insufficiency n — 3), fluid retention n = 4), and oliguria and macro hematuria n = 1 each). The patients had a median age of 57 (range 17-81) years and six had some predisposing condition (chronic renal insufficiency, heart failure, diabetes, use of diuretics) to NSAID-induced functional renal impairment. Apart from one patient, nimesulide was taken for a very short time (less than 8 days). A favorable outcome ensued after withdrawal of therapy in aU patients. The acute deterioration of renal function described in these patients pointed to hemodynamically mediated renal impairment in all cases, with the exception of one man in whom interstitial nephritis was suspected. 

Like other diuretics, triamterene occasionally causes interstitial nephritis (4), but it has also been responsible for other renal problems, notably reversible non-oliguric renal insufficiency when it is given along with indometa-cin (or presumably any other inhibitor of prostaglandin synthesis) (5). 

Magil AB, Ballon HS, Cameron EC, Rae A. Acute interstitial nephritis associated with thiazide diuretics. Am J Med 1980 69 939-943. 

Furo.semide and bumetanide are similar to the CA inhibilm. thiazides, and thiazide-like diuretics in possessing a. sulfanHnl moiety. This functional group has been associated with h)pei. sensitivity reactions such as urtic-aria. drug fever, bloixldyvt. sios. and interstitial nephritis. 

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-... 

The diuretics can result in an acute interstitial nephritis, which may have an immunologic basis and can persist, if undetected, as a chronic lesion leading to renal insufficiency. The acute form may or may not be associated with other hallmarks of an allergic phenomenon such as fever and rash, but eosinophilia and eosi-nophiluria are often present, if looked for. Thus far, this lesion has been associated with the administration of the thiazides and furosemide, but ethacrynic acid may also be involved. Persistent hypokalemia may also... 

Fialk MA, Romankiewicz J, Perrone F, Sherman RL. Allergic interstitial nephritis with diuretics. Ann Intern Med 1974 81 403-404. 

Fuller TJ, Barcenas CG, White MG. Diuretic-induced interstitial nephritis. JAMA 1976 235 1998-1999. 

Of the loop diuretics currently available, furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex) are widely used in the treatment of heart failure. Due to the increased risk of ototoxicity, ethacrynic acid (Edecrin) should be reserved for patients who are allergic to sulfonamides or who have developed interstitial nephritis on alternative drugs. 

Acute allergic interstitial nephritis Penicillins Ciprofloxacin Nonsteroidal anti-inllammatoiy drags, cyclooxygenase-2 inhibitors Proton pump inhibitors Loop diuretics... 

Diuretics Loops, thiazides, triamterene Acute interstitial nephritis, crystal nephropathy... 

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