Vasculitis renal

Trimethoprim produces the predictable adverse effects of an antifolate drug, especially megaloblastic anemia, leukopenia, and granulocytopenia. The combination trimethoprim-sulfamethoxazole may cause all of the untoward reactions associated with sulfonamides. Nausea and vomiting, drug fever, vasculitis, renal damage, and central nervous system disturbances occasionally occur also. Patients with AIDS and pneumocystis pneumonia have a particularly high frequency of untoward reactions to trimethoprim-sulfamethoxazole, especially fever, rashes, leukopenia, diarrhea, elevations of hepatic aminotransferases, hyperkalemia, and hyponatremia. 

The major side effects of allopurinol are skin rash, urticaria, leukopenia, GI problems, headache, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction occurs rarely but is associated with a 20% mortality rate. 

Pyelonephritis, interstitial nephritis Glomerulonephritis, renal infard, lupus nephritis, vasculitis... 

Penicillins Proton pump inhibitors Chronic interstitial nephritis Cyclosporine Lithium Aristolochic acid Renal vasculitis, thrombosis, and cholesterol emboli ... 

Adverse reactions may also include tachycardia hypertension palpitations syncope cerebrovascular accident vasodilation vasculitis gingivitis dyspepsia oral ulcer/abscess gastritis gastric ulcer hypersalivation dry mouth splenomegaly melena hematochezia esophagitis colitis pancreatitis pancytopenia neutropenia eosinophilia thrombocytopenia hepatitis hepatomegaly hepatic dysfunction renal... 

The main clinical uses of immunosuppressive drugs are suppression of organ and tissue rejection after transplant surgery and the treatment of diseases with an autoimmune component. Thses include renal diseases, e.g. glomerulonephritis, some nephrotic syndromes, connective tissue diseases, such as systemic lupus erythematosus rheumatoid arthritis, and systemic vasculitis. 

MMF is effective for the treatment of renal disease due to systemic lupus erythematosus and may be useful in vasculitis and Wegener s granulomatosis. Although MMF is occasionally used at a dosage of 2 g/d to treat rheumatoid arthritis, there are no well-controlled data regarding its efficacy in this disease. 

Antithyroid drugs, especially propylthiouracil, can be associated with the development of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pulmonary capillaritis (58) and lupus-like syndrome (59), have been described in individual cases. Furthermore, two cases of vasculitis have been associated with carbimazole, one presenting with eosinophilic granulomatous vasculitis localized to the stomach (60) and another with p-ANCA positive vasculitis causing simultaneous acute renal insufficiency and massive pulmonary hemorrhage (61). 

Cutaneous vasculitis is often a feature of such cases, although severe systemic manifestations often also occur. Two patients with propylthiouracil hypersensitivity presented with skin manifestations but also had renal, rheu-matological, and hematological features (66). A review of the literature showed that the symptoms and signs in patients with ANCA-associated thionamide-induced vasculitis are diverse. Acral purpuric skin lesions are typically seen recognition of these classical clinical features may allow early diagnosis and limit associated morbidity and the requirement for other therapies, particularly immunosuppression. Several other reports have described... 

Chronic overdose can cause a psychotic state mimicking schizophrenia. A vasculitis of the cerebral and/or renal vessels can occur, possibly due to release of vasoconstrictor amines from both platelets and nerve endings. Severe hypertension can result from the renal vasculitis. 

A hypersensitivity reaction characterized by multiple purpuric lesions and reduced renal function has been described in an elderly patient (SEDA-18, 103), and there have been reports of hypersensitivity vasculitis (SEDA-20, 91) (SEDA-21,103). 

Vasculitis due to a general hypersensitivity reaction can cause renal insufficiency and oliguria. Histological... 

There have been numerous reports of different rashes in association with ACE inhibitors. The most common skin reaction is a pruritic maculopapular eruption, which is reportedly more common with captopril (2-7%) than with enalapril (about 1.5%). This rash occurs in the usual dosage range and is more common in patients with renal insufficiency (70). Lichenoid reactions, bullous pemphigoid, exfoliative dermatitis, flushing and erythroderma, vasculitis/purpura, subcutaneous lupus erythematosus, and reversible alopecia have aU been reported (70-72). 

Shih DJ, Korbet SM, Rydel JJ, Schwartz MM. Renal vasculitis associated with ciprofloxacin. Am J Kidney Dis 1995 26(3) 516-19. 

Pons R, Escutia B. Vasculitis por ciprofloxacino con afecta-cion cutanea y renal. [Ciprofloxacin-induced vasculitis with cutaneous and renal involvement.] Nefrologia 2001 21(2) 209-12. 

Renal small-vessel vasculitis related to doxycycline has been reported (16). 

Goland S, Kazarsky R, Kagan A, Huszar M, Abend 1, Malnick SDH. Renal vasculitis associated with doxycycline. J Pharm Technol 2001 17 220-2. 

Leukocytoclastic vasculitis is a well-described and confirmed adverse effect of G-CSF, as documented in several reports, with recurrence after renewed administration of G-CSF (SEDA-19,343). Most cases were confined to the skin, and renal insufficiency with hematuria and proteinuria was noted in only very few patients. Based on 18 cases reported in the hterature or to the manufacturers, vasculitis was thought to have occurred in 6% of patients with chronic benign neutropenia, but in only six of about 200 000 patients with mahgnant disease (68). Vasculitis usually developed when the neutrophil count rose above 800 X 10 /1, suggesting that an increase in neutrophil count may play a role in necrotic vasculitis. Against this background, the occurrence of vascuhtis is not considered as treatment-hmiting and does not preclude further G-CSF administration if the absolute neutrophil count is lower than 1000 x 10 /1. 

GM-CSF can cause or exacerbate cutaneous leukocjho-clastic vascuhtis with possible renal or pulmonary involvement (SED-13, 1113). This adverse effect was substantiated by the prompt recurrence of vasculitis... 

Henoch-Schdnlein purpura developed in an 84-year-old Indian woman 10 days after she started to take clarithromycin (250 mg bd) for pneumonia (52). She was otherwise healthy and taking no regular medications. Histology confirmed a leukocytoclastic vasculitis of superficial vessels, with extravasation of erythrocytes, and direct immunofluorescence showed immunoglobulin A in superficial dermal vessels. Treatment with prednisone (1 mg/kg/day) was required. Most of the symptoms and signs resolved within a few days, but renal function remained impaired. 

Mizoribine is mostly well tolerated when it is used to treat different renal diseases, such as vasculitis, lupus nephritis, or nephritic syndrome (1-3). However, hemorrhagic enteritis and erosive changes in the intestinal mucosa have been found in dogs, and similar adverse effects have been reported in humans (4). 

Hirayama K, Kobayashi M, Hashimoto Y, Usui J, Shimizu Y, Hirayama A, Yoh K, Yamagata K, Nagase S, Nagata M, Koyama A. Treatment with the purine synthesis inhibitor mizoribine for ANCA-associated renal vasculitis. Am J Kidney Dis 2004 44(l) 57-63. 

Generalized reactions (26) include cutaneous necrotizing vasculitis (SEDA-5, 106) (SEDA-17, 113), nephritis, paralytic ileus, and angiitis with cutaneous, muscular, articular, and renal involvement (21). 

A leukocytoclastic vasculitis occurred in a 62-year-old woman with skin, peripheral nerve, and renal involvement (27). Long-term corticosteroid treatment caused gradually resolution. 

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