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1.
BMC Nephrol ; 17: 28, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-26980436

RESUMO

BACKGROUND: Acute interstitial nephritis (AIN) represents a frequent cause of acute kidney injury. While many etiologies of AIN have been recognized, the majority (60-70 %) are due to allergic reactions or drug exposure. Many different classes of drugs and several agents within a class can cause drug induced AIN. Flecainide, a class Ic antiarrhythmic drug, had thus far not been associated with the occurrence of AIN. CASE PRESENTATION: Here we describe a case of biopsy proven AIN after flecainide therapy in a pregnant patient. The 24-year old Caucasian woman was admitted to our university hospital for a planned c-section. She had been put on flecainide at a dose of 200 mg/d for supraventricular tachyarrhythmia of the fetus ten days earlier. The only fleaainide drug level was obtained 24 h after the last dose. At this time point the serum level was still in the therapeutic range (392 ng/mL). After hospital admission the patient underwent uneventful c-section and delivered a 3095 g baby girl with mild insufficiency of the tricuspid valve. In the hours following the c-section, a single dose of the non-steroidal anti-inflammatory drug (NSAID) ibuprofen (600 mg) as well as single dose of diclofenac (100 mg) was administered. Within 5 days after c-section her baseline creatinine of 30 µmol/L increased to 277 µmol/L. The serum creatinine continued to rise to 411 µmol/L on hospital day # 7. On renal ultrasound kidneys were enlarged and swollen. Urinary sediment at this point only revealed slight proteinuria (506 mg/g creatinine). A renal biopsy was performed showing acute interstitial nephritis. Within four days the renal function improved after discontinuation of flecainide and NSAIDs even without steroid therapy and the patient was discharged with a creatinine of 88 µmol/L after 13 days in the hospital. CONCLUSION: This case suggests that flecainide, at least in combination with NSAIDs, can cause AIN.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Antiarrítmicos/efeitos adversos , Arritmias Cardíacas/tratamento farmacológico , Doenças Fetais/tratamento farmacológico , Flecainida/efeitos adversos , Nefrite Intersticial/induzido quimicamente , Complicações na Gravidez/induzido quimicamente , Doença Aguda , Injúria Renal Aguda/patologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Diclofenaco/uso terapêutico , Feminino , Humanos , Ibuprofeno/uso terapêutico , Nefrite Intersticial/patologia , Gravidez , Complicações na Gravidez/patologia , Terceiro Trimestre da Gravidez , Adulto Jovem
2.
BMJ ; 345: e4565, 2012 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-22815429

RESUMO

OBJECTIVE: To evaluate the effect of different treatment strategies on enterohaemorrhagic Escherichia coli O104:H4 induced haemolytic uraemic syndrome. DESIGN: Multicentre retrospective case-control study. SETTING: 23 hospitals in northern Germany. PARTICIPANTS: 298 adults with enterohaemorrhagic E coli induced haemolytic uraemic syndrome. MAIN OUTCOME MEASURES: Dialysis, seizures, mechanical ventilation, abdominal surgery owing to perforation of the bowel or bowel necrosis, and death. RESULTS: 160 of the 298 patients (54%) temporarily required dialysis, with only three needing treatment long term. 37 patients (12%) had seizures, 54 (18%) required mechanical ventilation, and 12 (4%) died. No clear benefit was found from use of plasmapheresis or plasmapheresis with glucocorticoids. 67 of the patients were treated with eculizumab, a monoclonal antibody directed against the complement cascade. No short term benefit was detected that could be attributed to this treatment. 52 patients in one centre that used a strategy of aggressive treatment with combined antibiotics had fewer seizures (2% v 15%, P = 0.03), fewer deaths (0% v 5%, p = 0.029), required no abdominal surgery, and excreted E coli for a shorter duration. CONCLUSIONS: Enterohaemorrhagic E coli induced haemolytic uraemic syndrome is a severe self limiting acute condition. Our findings question the benefit of eculizumab and of plasmapheresis with or without glucocorticoids. Patients with established haemolytic uraemic syndrome seemed to benefit from antibiotic treatment and this should be investigated in a controlled trial.


Assuntos
Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Surtos de Doenças , Escherichia coli Êntero-Hemorrágica , Infecções por Escherichia coli/terapia , Síndrome Hemolítico-Urêmica/terapia , Fatores Imunológicos/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Antibacterianos/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Estudos de Casos e Controles , Criança , Terapia Combinada , Diarreia/microbiologia , Progressão da Doença , Quimioterapia Combinada , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Alemanha/epidemiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Síndrome Hemolítico-Urêmica/sangue , Síndrome Hemolítico-Urêmica/epidemiologia , Síndrome Hemolítico-Urêmica/microbiologia , Humanos , Fatores Imunológicos/administração & dosagem , Lactente , L-Lactato Desidrogenase/sangue , Masculino , Camundongos , Pessoa de Meia-Idade , Análise Multivariada , Plasmaferese/métodos , Contagem de Plaquetas , Diálise Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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