Renal failure, acute biopsy

Amphetamines have also been associated with a syndrome of acute kidney injury and rhabdomyolysis. Several series have described patients following intravenous injection of methamphetamine or phenmetrazine who presented with hyperactivity, fever, chills, sweats, abdominal cramps, diarrhea, and hypotension [177,178]. The patients have developed acute kidney injury which is usually oliguric and associated with classic rhabdomyolysis, similar to cases of cocaine-induced rhabdomyolysis. Several patients have had disseminated intravascular coagulation and liver function abnormalities as well. Methamphetamine abuse has also been associated with accelerated hypertension, unexplained chronic renal failure, acute lead poisoning (a common reagent used in its production utilizes lead acetate) and at least one case of biopsy proven interstitial nephritis the latter patient responded to intravenous corticosteroids but whether the nephritis was truly due to amphetamines remains unproven [179]. 

Renal Effects. Acute renal failure occurred in a man who washed his hair with an unknown amount of diesel fuel (Barrientos et al. 1977). In addition, he had oliguria biopsy revealed mitosis and vacuolization in renal cells, tubular dilation, and some cellular proliferation in the glomerulus. Another man developed acute tubular renal necrosis after washing his hands with an unspecified diesel fuel over several weeks (Crisp et al. 1979). Specifically, patchy degeneration and necrosis of the proximal and distal tubular epithelium with preservation of the basement membranes were noted. Also, increased blood urea nitrogen and serum creatinine levels were noted in this individual. Effects resulting from inhalation versus dermal exposure could not be distinguished in these cases. 

Renal Effects. In one individual, acute renal failure was noted from inhalation and/or dermal exposure to diesel fuel which was used as a shampoo. Biopsy detected tubular dilation, mitosis, and vacuolization in renal cells, and some cellular proliferation in the glomerulus in this individual (Barrientos et al. 1977). Another individual experienced renal failure following inhalation of diesel fuel vapor for 10 days (Reidenberg et al. 1964). Renal necrosis developed in one man after washing his hands with diesel fuel over several weeks (Crisp et al. 1979). Urinalysis was normal following inhalation of JP-5 by two individuals or ingestion of kerosene by numerous individuals (Dudin et al. 1991 Mahdi 1988 Nouri and Al-Rahim 1970 Porter 1990). 

A 36-year-old long-distance truck driver took 200 ml of ethylene glycol in a suicide attempt (32). He vomited, lost consciousness, and had miosis and external ophthalmoplegia. There was a severe metabolic acidosis with a wide anion gap and many crystals in the urinary sediment. Acute oliguric renal failure required continuous hemodialysis for 6 days. A CT scan of the brain showed low-density areas in the bilateral basal ganglia, midbrain, and pons. A renal biopsy showed tubular oxalate deposits. He gradually recovered within 36 days. 

AIN is characterized by fever, eosinophilia, hematuria, mild proteinuria and skin rash occur an average of 15 days after exposure (range 2-40). Rising serum creatinine concentration and acute renal failure with oliguria develop in about 50% of AIN cases, especially in older patients. Histologically, interstitial granulomas and variable degrees of tubular necrosis may be seen on renal biopsy. 

Acute interstitial nephritis was described by Lyons et al. in four patients with idiopathic interstitial nephritis, evidenced by peripheral eosinophilia, skin rash in two patients, and moderate to severe renal failure. Biopsies in all cases revealed dense interstitial infiltrate consisting predominantly of lymphocytes, tubular degenerative changes and interstitial edema with early... 

There have been multiple reports of acute kidney injury following the use of oral sodium phosphate solution [13,19-33]. Many of these reports are the subject of a recent review [19] and are best divided into 2 categories. In the first group of cases, the clinical course was dominated by immediate and severe electrolyte disorders including hyperphosphatemia, and renal biopsy was not performed [13, 20-28]. In the second group of patients, the clinical course was less acute and the connection between the use of OSPS and renal failure was confirmed by renal biopsy [19, 29-33]. 

In 2003, Desmeules et al. described a new pattern of renal failure resulting from the use of OSPS [29]. A 71-year-old female with a baseline creatinine of 1.0 mg/ dl presented with acute kidney injury and a creatinine of 4.5 mg/ dl two weeks following the use of OSPS. Renal biopsy revealed numerous tubular calcium phosphate deposits. Scanning electron microscopy and energy-dispersive x-ray microanalysis revealed that the calcium phosphate deposits formed crystals of hydroxyapatite. The patient s creatinine declined to 1.7 mg/dl at one year of follow-up. The authors described the process as "phosphosoda-induced nephrocalcinosis" and proposed the term "acute phosphate nephropathy". 

This dye, paraphenylenediamine, when mixed with henna, blackens the hair in a very short time. The substance is a common cause of ATN in the Sudan [30]. It is also toxic to the heart and hver. It is absorbed through the skin but individuals have ingested the dye in suicide attempts. Within 3-4 hours after ingestion they develop angioneurotic oedema soon followed by renal failure. Renal biopsy shows the typical features of acute tubular necrosis. See chapter 40. 

ACE inhibitors have emerged as a major cause of drug-induced ARF [9,14, 31, 48, 49]. Only a minority of ACE-inhibitor related cases have associated renal artery stenosis [31]. However, these groups of patients are older than the usual patient with drug-induced ARF, and more frequently are afflicted with underlying chronic renal failure [49]. When a renal biopsy is performed, it shows either severe arteriosclerosis of small renal arteries or acute tubular necrosis [31]. ACE inhibition followed by ARF may sometimes result in severe irreversible renal damage [31, 49] and even death [31]. 

Lamivudine, a weak inhibitor of organic cation transport by renal tubule epithelial cells [70], has also not been associated with significant nephrotoxicity. Acute renal failure with eosinophilic interstitial nephritis was attributed to abaca vir in one patient with HIV infection who also had what appeared to be "classic" FSGS on renal biopsy [71]. The serum creatinine returned to baseline levels after treatment with prednisone and discontinuation of abacavir. 

Several patients have also been reported with acute renal failure attributed to ritonavir [126-129]. Most of these patients were on other potentially nephrotoxic medications, and some had volume depletion or preexisting kidney disease. In several patients, ARF recurred upon rechallenge with ritonavir. None of the patients had renal biopsies performed, so there is no information on the histopafhologic correlates and etiology of the renal failure. 

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-... 

At least one case of acute interstitial nephritis has been attributed to amphetamine use [163]. This amphetamine abuser presented with acute nonoliguiic renal failure, large kidneys by ultrasonography, and microhematuria. The biopsy revealed interstitial edema and focal infiltrates of mononuclear cells and eosinophils with only patchy tubular degeneration. There was no evidence for rhabdomyolysis and the urine was negative for myoglobin. Although he required temporary hemodialytic support, renal function returned to normal after treatment with intravenous corticosteroids. The mechanism of this reaction remains unclear and its true relation to amphetamine abuse remains unproven. 

Acute renal failure has been associated with a variety of sedatives and hypnotics including barbiturates, benzodiazepines, glutethimide, and chlorpromazine [90, 91, 94, 102]. The acute renal failure is usually related to rhabdomyolysis but the classical clinical picture of acute interstitial nephritis has been reported in one patient with the use of diazepam, although no renal biopsy was performed [165]. In those patients with... 

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