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[Renal failure and rickets].

R Gastelbondo Amaya, F Mota Hernández, G Gordillo Paniagua

    Boletin Medico Del Hospital Infantil De Mexico
    |September 1, 1979
    PubMed
    Summary
    This summary is machine-generated.

    Diphenylhydantoin (phenytoin) use in an infant led to acute renal failure and rickets due to interstitial nephritis and vitamin D metabolism interference. Treatment with dehydrotachysterol improved rickets, while renal function slowly recovered.

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    Area of Science:

    • Pediatric Nephrology
    • Clinical Pharmacology
    • Endocrinology

    Background:

    • Diphenylhydantoin (phenytoin) is an anticonvulsant medication.
    • Previous reports link sodium diphenylhydantoins to interstitial nephritis and vitamin D metabolism interference, potentially causing or worsening rickets.
    • Vitamin D deficiency rickets can manifest with seizures due to hypocalcemia.

    Observation:

    • An infant presented with seizures, diagnosed with renal failure and rickets.
    • The infant had a history of convulsions treated with diphenylhydantoins for four months.
    • Renal biopsy confirmed interstitial nephritis.

    Findings:

    • The infant's seizures were attributed to hypocalcemic tetany, misdiagnosed as epilepsy and treated with diphenylhydantoins.

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  • Interstitial nephritis complicated by acute renal failure was likely induced by diphenylhydantoins.
  • Treatment with dehydrotachysterol led to clinical and radiological improvement of rickets, with gradual recovery of renal function.

    • Implications:

    • This case highlights the potential nephrotoxic and endocrine-disrupting effects of diphenylhydantoins in infants.
    • It underscores the importance of considering drug-induced conditions in the differential diagnosis of pediatric renal failure and rickets.
    • Accurate diagnosis and appropriate management, including vitamin D repletion and withdrawal of the offending drug, are crucial for favorable outcomes.