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[Sulfadiazine nephrolithiasis and nephropathy]

H Furrer1, J von Overbeck, P Jaeger

  • 1Medizinische Universitätspoliklinik, Inselspital Bern.

Schweizerische Medizinische Wochenschrift
|November 19, 1994
PubMed
Summary

High-dose sulfadiazine therapy for AIDS-related toxoplasmic encephalitis can cause kidney complications. Urine alkalinization is key for preventing and treating sulfadiazine-nephropathy and nephrolithiasis.

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Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • High-dose sulfadiazine therapy was historically associated with kidney complications like sulfadiazine-nephropathy and nephrolithiasis.
  • Recent widespread use of high-dose sulfadiazine for treating toxoplasmic encephalitis in patients with Acquired Immunodeficiency Syndrome (AIDS) has led to a resurgence of these renal complications.

Observation:

  • Two cases presenting with the characteristic clinical and pathological features of sulfadiazine-induced kidney injury are described.
  • The solubility of sulfadiazine and its primary metabolite is significantly enhanced in alkaline urine.

Findings:

  • Sulfadiazine-nephropathy and nephrolithiasis are increasingly prevalent in AIDS patients undergoing treatment for toxoplasmic encephalitis.
  • Urine alkalinization improves the solubility of sulfadiazine, offering a therapeutic and prophylactic strategy.

Implications:

  • Establishing clear guidelines for the prophylaxis and management of sulfadiazine-induced renal complications is crucial.
  • Urine pH monitoring and alkalinization should be considered standard practice during high-dose sulfadiazine therapy, especially in immunocompromised patients.

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