Interstitial nephritis sulfonamides

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... 

Renal complications that occur in relation to sulfonamide administration include crystalluria, tubular necrosis, interstitial nephritis, and glomerular lesions as part of a vasculitis syndrome. 

Allergic interstitial nephritis Penicillins, rifampin, sulfonamides, thiazides, cimetidine.phenytoin, allopurinol, furosemide, NSAIDS, ciprofloxacin, pantoprazole, omeprazole, atazanavir, bevacizumab Rash, fever, eosinophilia, eosinophiluria, pyuria... 

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). 

Acute interstitial nephritis Drugs Penicillins Ciprofloxacin Sulfonamides Infection Streptococcal... 

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]. 

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-... 

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. 

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