Acute angle closure triggered by oral benzodiazepines / Fechamento angular agudo desencadeado por uso oral de benzodiazepínicos

ABSTRACT Benzodiazepines are psychoactive drugs that are prescribed worldwide with limited information on their ocular side effects. Acute angle closure glaucoma is an adverse event with a high risk of blinding, especially in the elderly. We report two patients under 45 years old who presented with bilateral acute angle closure secondary to use of two long half-life benzodiazepines (clonazepam and alprazolam). In addition to suspending the use of these medications and administering ocular hypotensive drugs, both patients were successfully treated with bilateral peripheral laser iridotomy. To the best of our knowledge, this is the first report of bilateral acute angle closure secondary to the use of clonazepam and alprazolam.(AU)

RESUMO Os benzodiazepínicos são medicamentos psicoativos prescritos em todo o mundo, mas com poucas informações sobre seus efeitos colaterais oculares. O glaucoma por fechamento agudo do ângulo iridocorneano é um dos eventos adversos com maior risco de cegueira, sendo descrito particularmente em idosos. Relatamos aqui dois pacientes com menos de 45 anos de idade, com fechamento agudo do ângulo bilateral secundário ao uso de dois diferentes benzodiazepínicos de meia-vida longa (clonazepam e alprazolam). Além da suspensão dessas medicações e do tratamento clínico com drogas hipotensoras oculares, ambos os casos alcançaram sucesso com iridotomias periféricas bilaterais à laser. Considerando o conhecimento atual, estes são os primeiros relatos de fechamento agudo do ângulo bilateral secundária ao uso de clonazepam e alprazolam.(AU)

Acute angle closure triggered by oral benzodiazepines.

Benzodiazepines are psychoactive drugs that are prescribed worldwide with limited information on their ocular side effects. Acute angle closure glaucoma is an adverse event with a high risk of blinding, especially in the elderly. We report two patients under 45 years old who presented with bilateral acute angle closure secondary to use of two long half-life benzodiazepines (clonazepam and alprazolam). In addition to suspending the use of these medications and administering ocular hypotensive drugs, both patients were successfully treated with bilateral peripheral laser iridotomy. To the best of our knowledge, this is the first report of bilateral acute angle closure secondary to the use of clonazepam and alprazolam.

Recovery of renal function after bilateral renal vein thrombo sis episode as complication of membranous glomerulopa thy: case report / Recuperação da função renal após episódio de trombose de veia renal bilateral como complicação da glomerulopatia membranosa: relato de caso

ABSTRACT Renal vein thrombosis (RVT) is a complication often associated with nephrotic syndrome. It occurs due to a state of hypercoagulability common in the diseases that attend to this syndromic diagnosis. It should be suspected whenever there is nephrotic syndrome associated with sudden flank pain, hematuria and worsening of proteinuria. Bilateral RVT also presents with frequently oliguric renal dysfunction. This case reports a 33-year-old patient hospitalized for a nephrotic syndrome, with etiologic investigation suggestive of primary membranous glomerulopathy, which evolved with bilateral RVT associated with deterioration of renal function and need for renal replacement therapy. He promptly performed angiography with thrombectomy and thrombolysis, evolving with recovery of renal function in two weeks.

RESUMO A trombose de veia renal (TVR) é uma complicação muitas vezes associada à síndrome nefrótica. Ocorre devido a um estado de hipercoagulabilidade comum nas enfermidades que cursam com esse diagnóstico sindrômico. Deve ser suspeitada sempre que houver síndrome nefrótica associada à dor súbita em flanco, hematúria e piora da proteinúria. TVR bilateral cursa, ainda, com disfunção renal frequentemente oligúrica. Esse caso reporta um paciente de 33 anos internado por um quadro de síndrome nefrótica, com investigação etiológica sugestiva de glomerulopatia membranosa primária, que evoluiu com TVR bilateral associada à deterioração da função renal e necessidade de terapia substitutiva renal. Realizou, prontamente, angiografia com trombectomia e trombólise, evoluindo com recuperação da função renal em duas semanas.