RESUMO
BACKGROUND: Oxaliplatin is an anticancer therapy for pancreatic, gastric, and colorectal cancers. It is also used in patients with carcinomas of unknown primary sites. Oxaliplatin is associated with less frequent renal dysfunction than other conventional platinum-based drugs such as cisplatin. Albeit, there have been several reports of acute kidney injury with frequent use. In all cases, renal dysfunction was temporary and did not require maintenance dialysis. There have been no previous reports of irreversible renal dysfunction after a single dose of oxaliplatin. CASE PRESENTATION: Previous reports of oxaliplatin-induced renal injury occurred after patients received multiples doses. In this study, a 75-year-old male with unknown primary cancer and underlying chronic kidney disease developed acute renal failure after receiving the first dose of oxaliplatin. Suspected of having drug-induced renal failure through an immunological mechanism, the patient was treated with steroids; however, treatment was ineffective. Renal biopsy ruled out interstitial nephritis and revealed acute tubular necrosis. Renal failure was irreversible, and the patient subsequently required maintenance hemodialysis. CONCLUSIONS: We provide the first report of pathology-confirmed acute tubular necrosis after the first dose of oxaliplatin which led to irreversible renal dysfunction and maintenance dialysis.
Assuntos
Injúria Renal Aguda , Falência Renal Crônica , Necrose Tubular Aguda , Neoplasias Primárias Desconhecidas , Nefrite Intersticial , Masculino , Humanos , Idoso , Oxaliplatina/efeitos adversos , Neoplasias Primárias Desconhecidas/complicações , Diálise Renal/efeitos adversos , Falência Renal Crônica/complicações , Necrose Tubular Aguda/induzido quimicamente , Necrose Tubular Aguda/diagnóstico , Nefrite Intersticial/induzido quimicamente , Nefrite Intersticial/diagnóstico , Nefrite Intersticial/complicações , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Biópsia/efeitos adversos , NecroseRESUMO
INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p=0.77), DRF (p=0.73), need for dialysis (p=0.54), or appearance of post-surgical complications (p=0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results.
Assuntos
COVID-19 , Transplante de Rim , Pandemias , Adulto , Soro Antilinfocitário/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Isquemia Fria , Comorbidade , Diabetes Mellitus/epidemiologia , Suscetibilidade a Doenças , Feminino , Rejeição de Enxerto/prevenção & controle , Rejeição de Enxerto/terapia , Humanos , Hipertensão/epidemiologia , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Nefropatias/cirurgia , Transplante de Rim/métodos , Transplante de Rim/estatística & dados numéricos , Necrose Tubular Aguda/induzido quimicamente , Necrose Tubular Aguda/prevenção & controle , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Transplante de Pâncreas/estatística & dados numéricos , Plasmaferese , Terapia de Substituição Renal , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Risco , Espanha/epidemiologia , Resultado do TratamentoAssuntos
Necrose Tubular Aguda/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Receptores de Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Idoso , Humanos , Necrose Tubular Aguda/metabolismo , Masculino , Inibidores de Proteínas Quinases/uso terapêutico , Neoplasias Urológicas/tratamento farmacológico , Neoplasias Urológicas/metabolismoRESUMO
Intravascular hemolysis of any cause can induce acute kidney injury (AKI). Hemolysis-derived product heme activates the innate immune complement system and contributes to renal damage. Therefore, we explored the role of the master complement regulator Factor H (FH) in the kidney's resistance to hemolysis-mediated AKI. Acute systemic hemolysis was induced in mice lacking liver expression of FH (hepatoFH-/-, ~20% residual FH) and in WT controls, by phenylhydrazine injection. The impaired complement regulation in hepatoFH-/- mice resulted in a delayed but aggravated phenotype of hemolysis-related kidney injuries. Plasma urea as well as markers for tubular (NGAL, Kim-1) and vascular aggression peaked at day 1 in WT mice and normalized at day 2, while they increased more in hepatoFH-/- compared to the WT and still persisted at day 4. These were accompanied by exacerbated tubular dilatation and the appearance of tubular casts in the kidneys of hemolytic hepatoFH-/- mice. Complement activation in hemolytic mice occurred in the circulation and C3b/iC3b was deposited in glomeruli in both strains. Both genotypes presented with positive staining of FH in the glomeruli, but hepatoFH-/- mice had reduced staining in the tubular compartment. Despite the clear phenotype of tubular injury, no complement activation was detected in the tubulointerstitium of the phenylhydrazin-injected mice irrespective of the genotype. Nevertheless, phenylhydrazin triggered overexpression of C5aR1 in tubules, predominantly in hepatoFH-/- mice. Moreover, C5b-9 was deposited only in the glomeruli of the hemolytic hepatoFH-/- mice. Therefore, we hypothesize that C5a, generated in the glomeruli, could be filtered into the tubulointerstitium to activate C5aR1 expressed by tubular cells injured by hemolysis-derived products and will aggravate the tissue injury. Plasma-derived FH is critical for the tubular protection, since pre-treatment of the hemolytic hepatoFH-/- mice with purified FH attenuated the tubular injury. Worsening of acute tubular necrosis in the hepatoFH-/- mice was trigger-dependent, as it was also observed in LPS-induced septic AKI model but not in chemotherapy-induced AKI upon cisplatin injection. In conclusion, plasma FH plays a key role in protecting the kidneys, especially the tubules, against hemolysis-mediated injury. Thus, FH-based molecules might be explored as promising therapeutic agents in a context of AKI.
Assuntos
Ativação do Complemento , Fator H do Complemento/metabolismo , Hemólise , Hepatócitos/metabolismo , Glomérulos Renais/metabolismo , Necrose Tubular Aguda/prevenção & controle , Túbulos Renais/metabolismo , Animais , Complemento C5a/genética , Complemento C5a/metabolismo , Fator H do Complemento/genética , Modelos Animais de Doenças , Regulação da Expressão Gênica , Glomérulos Renais/patologia , Necrose Tubular Aguda/sangue , Necrose Tubular Aguda/induzido quimicamente , Necrose Tubular Aguda/patologia , Túbulos Renais/patologia , Camundongos Endogâmicos C57BL , Camundongos Knockout , Fenil-Hidrazinas , Receptor da Anafilatoxina C5a/genética , Receptor da Anafilatoxina C5a/metabolismo , Transdução de SinaisRESUMO
We present the case of ceftazidime-induced immune-mediated haemolysis with associated acute kidney injury in a 43-year-old woman. The patient initially presented to the regional cystic fibrosis centre for treatment of an infective exacerbation of cystic fibrosis. After initiation of ceftazidime (a third-generation cephalosporin), renal function rapidly deteriorated and a fall in haemoglobin was noted. On transfer to our care, a haemolysis screen identified immune-mediated haemolysis, and renal biopsy confirmed the finding of acute tubular necrosis secondary to haem pigment. The patient's renal function deteriorated such that she required haemodialysis, although she subsequently recovered and is now dialysis-independent. Although acute haemolytic reactions are recognised with third-generation cephalosporins, this is the first reported case of ceftazidime-induced immune-mediated haemolysis with acute kidney injury. Given the increased frequency of cephalosporin usage, it is important for both nephrologists and general physicians to be aware of this rare but very serious complication.
Assuntos
Antibacterianos/efeitos adversos , Ceftazidima/efeitos adversos , Hemólise/imunologia , Necrose Tubular Aguda/induzido quimicamente , Adulto , Fibrose Cística/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Necrose Tubular Aguda/diagnóstico , Necrose Tubular Aguda/imunologia , Necrose Tubular Aguda/terapiaRESUMO
The introduction of more efficient antiviral drugs are common cause drug-induced acute kidney injury (AKI). The true prevalence of antiviral drugs induced nephrotoxicity is hardly determined. It causes AKI by many mechanisms including acute tubular necrosis (ATN), allergic interstitial nephritis (AIN), and crystal nephropathy. ATN has been described with a few kinds of antiviral drugs such as cidofovir, adefovir and tenofovir with unique effects on transporter defects, apoptosis, and mitochondrial injury. AIN from atazanavir is a rapid onset of AKI and usually nonoliguric but dialytic therapy are needed because of severity. Additionally, crystal nephropathy from acyclovir, indinavir, and foscarnet can cause AKI due to intratubular obstruction. In this article, the mechanisms of antiviral drug-induced AKI were reviewed and strategies for preventing AKI were mentioned.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Antivirais/efeitos adversos , Apoptose/efeitos dos fármacos , Humanos , Necrose Tubular Aguda/induzido quimicamente , Mitocôndrias/efeitos dos fármacos , Nefrite Intersticial/induzido quimicamenteRESUMO
Antibiotics are widely prescribed and have a generally favorable safety profile. Common adverse effects such as rash and diarrhea are well recognized, but less common ones may go unrecognized. This review highlights rare but potentially lethal complications associated with antibiotics.
Assuntos
Antibacterianos/efeitos adversos , Encefalopatias/induzido quimicamente , Necrose Tubular Aguda/induzido quimicamente , Síndrome do QT Longo/induzido quimicamente , Lúpus Eritematoso Sistêmico/induzido quimicamente , Convulsões/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Drug-induced kidney injury, a major cause of acute kidney injury, results in progressive kidney disease and is linked to increased mortality in hospitalized patients. Primary injury sites of drug-induced kidney injury are proximal tubules. Clinically, kidney injury molecule-1, an established tubule-specific biomarker, is monitored to assess the presence and progression of injury. The ability to accurately predict drug-related nephrotoxicity preclinically would reduce patient burden and drug attrition rates, yet state-of-the-art in vitro and animal models fail to do so. In this study, we demonstrate the use of kidney injury molecule-1 measurement in the kidney microphysiological system as a preclinical model for drug toxicity assessment. To show clinical relevance, we use quantitative systems pharmacology computational models for in vitro-in vivo translation of the experimental results and to identify favorable dosing regimens for one of the tested drugs.
Assuntos
Cisplatino/efeitos adversos , Gentamicinas/efeitos adversos , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Necrose Tubular Aguda/induzido quimicamente , Rifampina/efeitos adversos , Biomarcadores/metabolismo , Linhagem Celular , Cisplatino/farmacocinética , Humanos , Necrose Tubular Aguda/metabolismo , Túbulos Renais Proximais/citologia , Túbulos Renais Proximais/efeitos dos fármacos , Túbulos Renais Proximais/metabolismo , Modelos Teóricos , Rifampina/farmacocinética , Pesquisa Translacional BiomédicaRESUMO
BACKGROUND: Acyclovir is one of the most common prescribed antiviral drugs. Acyclovir nephrotoxicity occurs in approximately 12-48% of cases. It can present in clinical practice as acute kidney injury (AKI), crystal-induced nephropathy, acute tubulointerstitial nephritis, and rarely, as tubular dysfunction. Electrolytes abnormalities like hypokalemia, were previously described only when given intravenously. CASE PRESENTATION: A 54 year-old female presented with weakness and lower extremities paresis, nausea and vomiting after receiving oral acyclovir. Physical examination disclosed a decrease in the patellar osteotendinous reflexes (++ / ++++). Laboratory data showed a serum creatinine level of 2.1 mg/dL; serum potassium 2.1 mmol/L. Kidney biopsy was obtained; histological findings were consistent with acute tubular necrosis and acute tubulointerstitial nephritis. The patient was advised to stop the medications and to start with oral and intravenous potassium supplement, symptoms improved and continued until serum potassium levels were > 3.5 meq/L. CONCLUSIONS: The case reported in this vignette is unique since it is the first one to describe hypokalemia associated to acute tubular necrosis induced by oral acyclovir.
Assuntos
Aciclovir/efeitos adversos , Antivirais/efeitos adversos , Hipopotassemia/induzido quimicamente , Hipopotassemia/patologia , Necrose Tubular Aguda/induzido quimicamente , Necrose Tubular Aguda/patologia , Aciclovir/administração & dosagem , Administração Oral , Antivirais/administração & dosagem , Feminino , Humanos , Hipopotassemia/sangue , Necrose Tubular Aguda/sangue , Pessoa de Meia-IdadeRESUMO
The term acute tubular necrosis was thought to represent a misnomer derived from morphological studies of human necropsies and necrosis was thought to represent an unregulated passive form of cell death which was not amenable to therapeutic manipulation. Recent advances have improved our understanding of cell death in acute kidney injury. First, apoptosis results in cell loss, but does not trigger an inflammatory response. However, clumsy attempts at interfering with apoptosis (e.g. certain caspase inhibitors) may trigger necrosis and, thus, inflammation-mediated kidney injury. Second, and most revolutionary, the concept of regulated necrosis emerged. Several modalities of regulated necrosis were described, such as necroptosis, ferroptosis, pyroptosis and mitochondria permeability transition regulated necrosis. Similar to apoptosis, regulated necrosis is modulated by specific molecules that behave as therapeutic targets. Contrary to apoptosis, regulated necrosis may be extremely pro-inflammatory and, importantly for kidney transplantation, immunogenic. Furthermore, regulated necrosis may trigger synchronized necrosis, in which all cells within a given tubule die in a synchronized manner. We now review the different modalities of regulated necrosis, the evidence for a role in diverse forms of kidney injury and the new opportunities for therapeutic intervention.
Assuntos
Necrose Tubular Aguda/patologia , Terapia de Alvo Molecular/métodos , Necrose/fisiopatologia , Animais , Apoptose , Oxalato de Cálcio/toxicidade , Cisplatino/toxicidade , Citocinas/fisiologia , Avaliação Pré-Clínica de Medicamentos , Ácido Fólico/toxicidade , Humanos , Rim/irrigação sanguínea , Necrose Tubular Aguda/induzido quimicamente , Necrose Tubular Aguda/tratamento farmacológico , Camundongos , Camundongos Knockout , Proteínas de Transporte da Membrana Mitocondrial/fisiologia , Poro de Transição de Permeabilidade Mitocondrial , Modelos Biológicos , Necrose/classificação , Necrose/tratamento farmacológico , Necrose/imunologia , Traumatismo por Reperfusão/patologia , Terminologia como AssuntoRESUMO
Two patients developed kidney failure due to oxalate deposition in the kidney while taking orlistat. Cessation of orlistat was followed by partial recovery of kidney function. The mechanism by which orlistat causes hyperoxaluria and the management of orlistat-induced oxalate nephropathy is reviewed. We suggest that all patients taking orlistat are at risk of this condition, which may develop insidiously and is easily overlooked. Monitoring of kidney function of patients taking orlistat is warranted.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Hiperoxalúria/induzido quimicamente , Necrose Tubular Aguda/induzido quimicamente , Lactonas/efeitos adversos , Insuficiência Renal Crônica/induzido quimicamente , Idoso , Fármacos Antiobesidade/administração & dosagem , Oxalato de Cálcio/urina , Feminino , Humanos , Hiperoxalúria/diagnóstico por imagem , Necrose Tubular Aguda/diagnóstico por imagem , Necrose Tubular Aguda/patologia , Lactonas/administração & dosagem , Masculino , Microscopia , Obesidade/tratamento farmacológico , OrlistateRESUMO
BACKGROUND: Pemetrexed maintenance therapy holds tremendous potential in improving the survival of patients with advanced pulmonary adenocarcinoma. Major side effects include myelosuppression and cutaneous reactions. However, little data are available on pemetrexed nephrotoxicity. Our case describes clinically relevant renal events leading to treatment discontinuation in routine practice. CASE PRESENTATION: We report a case of a 69-year-old Moroccan man treated for metastatic non-small cell lung cancer. He was not on any other medications and he did not receive any nephrotoxic agents. He was exposed to intravenously administered contrast from thoracoabdominal computed tomography in the week of his last pemetrexed treatment. He developed kidney disease related to pemetrexed. He was submitted to renal biopsy, which showed acute tubular damage and interstitial fibrosis. His kidney function remained impaired, but stable, after discontinuation of pemetrexed therapy. He died 5 months later. CONCLUSIONS: Medical oncologists should be aware of renal adverse events for patients with advanced non-small cell lung cancer eligible for pemetrexed maintenance therapy. Suggestions for mitigating the risk for renal toxicities (dehydration, non-steroidal anti-inflammatory drugs and zoledronic acid, radiocontrast agents) during pemetrexed maintenance should be followed to enable early detection and management of this adverse event.
Assuntos
Antineoplásicos/efeitos adversos , Necrose Tubular Aguda/induzido quimicamente , Túbulos Renais/efeitos dos fármacos , Pemetrexede/efeitos adversos , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma de Pulmão , Idoso , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Evolução Fatal , Humanos , Túbulos Renais/patologia , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Tomografia Computadorizada por Raios X , Suspensão de TratamentoRESUMO
BACKGROUND: Acute granulomatous interstitial nephritis (AGIN) in native kidneys is most commonly linked to drugs. In allografts, it is a rare complication, and it occurs mostly with infections. CASE PRESENTATION: Our case report presents AGIN with simultaneous acute cellular rejections and acute tubular necrosis in a kidney transplant patient 2 weeks after intravenous application of zoledronic acid. A kidney biopsy showed signs of destructive AGIN with acute cellular rejection. After treatment with methylprednisolone pulses and immunosuppressive therapy modification, rebiopsy confirmed complete regression of AGIN with less intense persistent acute cellular rejection and acute tubular necrosis. Kidney function improved after glucocorticoid and intravenous immunoglobulin G therapy. CONCLUSION: To our knowledge, this is the first case of AGIN related to bisphosphonate zoledronate in a kidney transplant patient with consequent acute cellular rejection. In using intravenous zoledronate infusion in a kidney transplant recipient, we should be aware that it could potentially induce acute granulomatous tubulointerstitial nephritis and acute rejection.â©.
Assuntos
Difosfonatos/efeitos adversos , Rejeição de Enxerto/induzido quimicamente , Granuloma/induzido quimicamente , Imidazóis/efeitos adversos , Transplante de Rim/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Doença Aguda , Adulto , Feminino , Humanos , Necrose Tubular Aguda/induzido quimicamente , Ácido ZoledrônicoRESUMO
Thinners are mixtures of organic solvents commonly containing toluene, xylene, acetone, hexane, benzene and methyl isobutyl ketone. This report describes a case of rhabdomyolysis with acute tubular necrosis and renal failure, most likely attributable to toluene, following occupational exposure to thinners while cleaning a steel water tank. These adverse health effects have previously been reported following acute poisoning or intentional inhalation by drug abusers, but rarely in the occupational setting. Poor working conditions, lack of health and safety training and delayed treatment contributed to the onset and severity of the patient's complications. This case emphasizes the need for strict control measures, including adequate ventilation, training on working in confined spaces, appropriate personal protective equipment and emergency rescue procedures in such settings. In addition, rhabdomyolysis, acute tubular necrosis and renal failure should be added to safety data material as possible complications of excessive inhalation of thinners.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Necrose Tubular Aguda/induzido quimicamente , Rabdomiólise/induzido quimicamente , Solventes/intoxicação , Tolueno/intoxicação , Injúria Renal Aguda/diagnóstico , Adulto , Espaços Confinados , Humanos , Exposição por Inalação , Necrose Tubular Aguda/diagnóstico , Masculino , Exposição Ocupacional , Rabdomiólise/diagnóstico , África do Sul , Compostos Orgânicos Voláteis/intoxicaçãoAssuntos
Antivirais/efeitos adversos , Infecções por HIV/tratamento farmacológico , Necrose Tubular Aguda/induzido quimicamente , Tenofovir/efeitos adversos , Diagnóstico Diferencial , Fadiga/etiologia , HIV , Humanos , Rim/patologia , Necrose Tubular Aguda/diagnóstico , Necrose Tubular Aguda/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Tenofovir/uso terapêuticoRESUMO
Preapproval clinical trials examining the safety and efficacy of rosuvastatin demonstrated an increased incidence of proteinuria, hematuria, rhabdomyolysis, and other acute kidney injury of unknown cause at high doses. The latter cases manifested with urine sediment findings and in some cases, renal histology, indicating renal tubular injury in the absence of rhabdomyolysis. Despite these provocative findings, there have been very few reports in the literature regarding non-rhabdomyolysis-mediated acute kidney injury associated with high-dose rosuvastatin since its widespread introduction more than a decade ago, suggesting that it is either a rare entity or systematically underdiagnosed and under-reported. We present a case of renal tubular toxicity attributable to the initiation of rosuvastatin treatment at a dose of 40mg in a patient with no prior evidence of kidney disease. Tubular toxicity should be considered in cases of unexplained kidney injury in the setting of exposure to a potent statin such as rosuvastatin, particularly at high dose. The limited evidence suggests a good kidney prognosis following withdrawal of the agent in these cases.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Necrose Tubular Aguda/induzido quimicamente , Rosuvastatina Cálcica/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
This study investigated the pretreatment and post-treatment effects of dipyridamole (20 mg/kg/day, p.o.) in gentamicin-induced acute nephrotoxicity in rats. Rats were administered gentamicin (100 mg/kg/day, i.p.) for 8 days. Gentamicin-administered rats exhibited renal structural and functional changes as assessed in terms of a significant increase in serum creatinine and urea and kidney weight to body weight ratio as compared to normal rats. Renal histopathological studies revealed a marked incidence of acute tubular necrosis in gentamicin-administered rats. These renal structural and functional abnormalities in gentamicin-administered rats were accompanied with elevated serum uric acid level, and renal inflammation as assessed in terms of decrease in interleukin-10 levels. Dipyridamole pretreatment in gentamicin-administered rats afforded a noticeable renoprotection by markedly preventing renal structural and functional abnormalities, renal inflammation and serum uric acid elevation. On the other hand, dipyridamole post-treatment did not significantly prevent uric acid elevation and renal inflammation, and resulted in comparatively less protection on renal function although it markedly reduced the incidence of tubular necrosis. In conclusion, uric acid elevation and renal inflammation could play key roles in gentamicin-nephrotoxicity. Dipyridamole pretreatment markedly prevented gentamicin-induced acute nephrotoxicity, while its post-treatment resulted in comparatively less renal functional protection.
Assuntos
Anti-Inflamatórios/farmacologia , Dipiridamol/farmacologia , Gentamicinas , Necrose Tubular Aguda/tratamento farmacológico , Necrose Tubular Aguda/prevenção & controle , Rim/efeitos dos fármacos , Nefrite/tratamento farmacológico , Nefrite/prevenção & controle , Animais , Biomarcadores/sangue , Creatinina/sangue , Citoproteção , Modelos Animais de Doenças , Interleucina-10/sangue , Rim/metabolismo , Rim/patologia , Necrose Tubular Aguda/sangue , Necrose Tubular Aguda/induzido quimicamente , Masculino , Nefrite/sangue , Nefrite/induzido quimicamente , Ratos Sprague-Dawley , Fatores de Tempo , Ácido Úrico/sangueRESUMO
Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.
Assuntos
Bloqueadores dos Canais de Cálcio/efeitos adversos , Diltiazem/efeitos adversos , Overdose de Drogas/complicações , Necrose Tubular Aguda/induzido quimicamente , Biópsia , Humanos , Rim/patologia , Necrose Tubular Aguda/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Aminoglycosides (AG) cause nephrotoxicity in 10 - 20% of patients. One of the mechanisms is by generating reactive oxygen species (ROS), leading to DNA destruction and activation of poly(ADPribose) polymerase (PARP) causing necrotic tubular cell death. PARP inhibition on gentamicin-induced nephrotoxicity was studied. METHODS: 19 female Wistar-Kyoto rats divided into 3 groups: control (3 rats receiving no treatment); gentamicin-treated group (8 rats); and 8 rats treated with gentamicin combined with 3-aminobenzamide (3 AB). Kidney functions, protein, and gentamicin levels as well as urinary trypsin inhibitory activity (TIA) were measured. Tissue microscopic examination and immunohistochemical study for proliferative cell nuclear antigen (PCNA) were determined. The effect of PARP inhibitor on the bactericidal activity of gentamicin was also assessed. RESULTS: The following results were statistically significant: urea (mg/dL) 39.9 ± 5.86, 88.3 ± 50.3, and 48.5 ± 12.7 (p = 0.048); serum creatinine (mg/dL): 0.6 ± 0.26, 1.05 ± 0.7, 0.6 ± 0.06 (p = 0.043); proteinuria (mg/24-hours): 7.27 ± 3.65, 41.2 ± 18.1, and 17.6 ± 13.9 (p = 0.050); the number of tubular macronuclei (per 10 mm2): 18.33 ± 16.07, 218 ± 101.8, 41.7 ± 36.2 (p = 0.012); the number of dilated tubes (per 10 mm2): 61.67 ± 12.58, 276.3 ± 112.7, 140.0 ± 90.9 (p = 0.04); and the number of PCNA positive nuclei (per 10 mm2): 223.3 ± 95.69, 3,585 ± 2,215.3, 626.7 ± 236.9 (p = 0.034) in the control, gentamicin, and gentamicin+3AB-treated groups, respectively. The following biochemical and histologic parameters were also examined, however, they showed no statistically significant difference: TIA (p = 0.055), mitoses (p = 0.14), mononuclear infiltrate (p = 0.188), and intratubular cast formation (p = 0.084). No effect on bactericidal activity was observed. CONCLUSION: This study illustrates that PARP inhibitor significantly attenuates gentamicin-induced nephrotoxicity in rats with no effect on the bactericidal activity.