Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report
The patient was an 80-year-old man who arrived at the emergency room with breathing problems. He presented a history of chronic obstructive pulmonary disease (COPD), hypertension, diabetes mellitus and early (stage 1) chronic renal failure with normal levels of creatinine and no sign and symptoms of...
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Edizioni FS
2017-07-01
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| Series: | Journal of Health and Social Sciences |
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| author | Gabriella Nucera Valentina Raffaelli Lisa Caliari Giulia Cantoni Pietro Marino |
| author_facet | Gabriella Nucera Valentina Raffaelli Lisa Caliari Giulia Cantoni Pietro Marino |
| author_sort | Gabriella Nucera |
| collection | DOAJ |
| description | The patient was an 80-year-old man who arrived at the emergency room with breathing problems. He presented a history of chronic obstructive pulmonary disease (COPD), hypertension, diabetes mellitus and early (stage 1) chronic renal failure with normal levels of creatinine and no sign and symptoms of renal disease. A chest X-ray showed pneumonia. Therefore, he was first treated with 1 g daily of ceftriaxone IV. We did not observe any clinical improvement, and for this reason, a sputum culture was performed to guide the right antibiotic treatment. Subsequently, we started a new antibiotic therapy with trimethoprim/sulfamethoxazole (TMP/SMX) adjusted to renal functioning. Appropriate medical treatment was administered, as well as urine alkalinisation. After the first day of treatment, the patient’s clinical and laboratory status worsened very quickly, with an increased level of serum creatinine from 1.5 to 3.5 mg/dL. We stopped administering the antibiotic therapy immediately. However, we observed acute renal failure with a serum creatinine level of 9.0 mg/dL and four days after his admission, the patient
died. Literature showed that patients can develop acute kidney injury (AKI) during or immediately following TMP/SMX therapy. Intrinsic renal impairment –rather, interstitial nephritis– appeared
responsible for the great majority of cases, and impairment was transient if therapy was discontinued.
In our study, despite the therapy with TMP/SMX was immediately discontinued, and our patient underwent appropriate medical treatment, urine alkalinisation and, then, haemodialysis, the AKI was rapidly fatal.
In conclusion, particular attention should be paid to prescribing TMP/SMX to patients affected by chronic renal failure. |
| format | Article |
| id | doaj-art-7581b3994eb449299d103fb733050160 |
| institution | Kabale University |
| issn | 2499-2240 2499-5886 |
| language | English |
| publishDate | 2017-07-01 |
| publisher | Edizioni FS |
| record_format | Article |
| series | Journal of Health and Social Sciences |
| spelling | doaj-art-7581b3994eb449299d103fb7330501602025-01-18T18:20:31ZengEdizioni FSJournal of Health and Social Sciences2499-22402499-58862017-07-012221522010.19204/2017/trmt8Trimethoprim/sulfamethoxazole-induced acute renal failure: A case reportGabriella Nucera0Valentina Raffaelli1Lisa Caliari2Giulia Cantoni3Pietro Marino4Department of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, ItalyDepartment of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, ItalyDepartment of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, ItalyDepartment of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, ItalyDepartment of Emergency, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, ItalyThe patient was an 80-year-old man who arrived at the emergency room with breathing problems. He presented a history of chronic obstructive pulmonary disease (COPD), hypertension, diabetes mellitus and early (stage 1) chronic renal failure with normal levels of creatinine and no sign and symptoms of renal disease. A chest X-ray showed pneumonia. Therefore, he was first treated with 1 g daily of ceftriaxone IV. We did not observe any clinical improvement, and for this reason, a sputum culture was performed to guide the right antibiotic treatment. Subsequently, we started a new antibiotic therapy with trimethoprim/sulfamethoxazole (TMP/SMX) adjusted to renal functioning. Appropriate medical treatment was administered, as well as urine alkalinisation. After the first day of treatment, the patient’s clinical and laboratory status worsened very quickly, with an increased level of serum creatinine from 1.5 to 3.5 mg/dL. We stopped administering the antibiotic therapy immediately. However, we observed acute renal failure with a serum creatinine level of 9.0 mg/dL and four days after his admission, the patient died. Literature showed that patients can develop acute kidney injury (AKI) during or immediately following TMP/SMX therapy. Intrinsic renal impairment –rather, interstitial nephritis– appeared responsible for the great majority of cases, and impairment was transient if therapy was discontinued. In our study, despite the therapy with TMP/SMX was immediately discontinued, and our patient underwent appropriate medical treatment, urine alkalinisation and, then, haemodialysis, the AKI was rapidly fatal. In conclusion, particular attention should be paid to prescribing TMP/SMX to patients affected by chronic renal failure.http://journalhss.com/wp-content/uploads/jhhs22_215-220.pdfacute; trimethoprim/ sulfamethoxazoleAcute kidney injuryanti-Bacterial agentsrenal insufficiency acutetrimethoprim/sulfamethoxazole |
| spellingShingle | Gabriella Nucera Valentina Raffaelli Lisa Caliari Giulia Cantoni Pietro Marino Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report Journal of Health and Social Sciences acute; trimethoprim/ sulfamethoxazole Acute kidney injury anti-Bacterial agents renal insufficiency acute trimethoprim/sulfamethoxazole |
| title | Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report |
| title_full | Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report |
| title_fullStr | Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report |
| title_full_unstemmed | Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report |
| title_short | Trimethoprim/sulfamethoxazole-induced acute renal failure: A case report |
| title_sort | trimethoprim sulfamethoxazole induced acute renal failure a case report |
| topic | acute; trimethoprim/ sulfamethoxazole Acute kidney injury anti-Bacterial agents renal insufficiency acute trimethoprim/sulfamethoxazole |
| url | http://journalhss.com/wp-content/uploads/jhhs22_215-220.pdf |
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