Renal impairment crystalluria

Co-amoxiclav consists of the combination of amoxicillin (penicillin antibacterial agent) and clavulanic acid (beta-lactamase inhibitor) which is associated with a risk of crystalluria in patients with renal impairment who are receiving high doses, particularly during parenteral therapy. 

Figure 1. Sulfadiazine nephrotoxicity (crystalluria and acute renal failure). 35 year old man with AIDS and cerebral toxoplasmosis treated for 33 days with 4-6 g/dayofsulfadiazine.The patient received oral hydration and possibly had an episode of transient renal impairment during days 8-13. By day 29 of treatment, crystalluria, hematuria, flank pain, renal calculi, and acute renal failure developed. Urine was alkalinized late in the course.

Antineoplastic, immunosuppressant cell cycle-specific drug that inhibits dihydrofolate reductase. Major dose reduction required in renal impairment. Tox GI distress, myelosuppression, crystalluria. Leucovorin rescue used to reduce toxicity. 

Renal/Hepatic function impairment Use with caution. Maintain adequate fluid intake to prevent crystalluria and stone formation. Patients with severely impaired renal function exhibit an increase in the half-lives of both TMP and SMZ, requiring dosage regimen adjustment. 

Fewer than 0.1% of patients receiving sulhsoxazole suffer serious toxic reactions. The untoward effects prodnced by this agent are similar to those that follow the administration of other sulfonamides. Because of its relatively high solubility in the urine as compared with sulfadiazine, sulhsoxazole only infrequently produces hematuria or crystalluria (0.2 to 0.3%). Despite this, patients taking this drug should ingest an adequate quantity of water. Sulhsoxazole and all snlfonamides that are absorbed must be used with caution in patients with impaired renal function. Like all sulfonamides, sulhsoxazole may produce hypersensitivity reactions, some of which are potentially lethal. Sulhsoxazole currently is preferred over other snlfonamides by most clinicians when a rapidly absorbed and rapidly exaeted sulfonamide is indicated. 

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