Atypical renal failure | Revista Clínica Española

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Núñez Orantos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Tornero Romero" "email" => array:1 [ 0 => "ftornero_r@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Cabello Clotet" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Núñez Orantos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracaso renal atípico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 900 "Tamanyo" => 39294 ] ] ] ] "textoCompleto" => "A 67-year-old man was hospitalized for a study of constitutional syndrome with significant asthenia, loss of 15kg of weight and cessation of self-care. The patient was diagnosed with human immunodeficiency virus infection C3 and cerebral toxoplasmosis and was started on treatment with sulfadiazine (1.5g/6h orally), pyrimethamine (75mg/day orally) and folinic acid (15mg/day orally). At 5 days, the patient's general condition deteriorated, presenting spatial and temporal disorientation and oligoanuria, with a diuresis rate of 10mL/h and a creatinine level of 3.7mg/dL. After observing the urine sediment under microscope (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), we reached the diagnosis of the patient's type of renal failure.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In tubular necrosis by sulfadiazine crystals, the urine sediment study plays an essential role by observing crystals of the N-acetyl-sulfadiazine metabolite forming structures characteristically described as “fan-shaped” or in “sheaves of wheat”. The presence of crystalluria per se is not diagnostic of the condition but should lead to strict renal function monitoring. In terms of treatment, the most effective measures have been blood volume expansion and urine alkalinization.Sulfadiazine-induced renal toxicity has been well known since the 1940s. The emergence of more water-soluble sulfonamides and new antibiotics means that general physicians are less accustomed to its toxicity. In the era of technological sophistication, a diagnostic test as elemental as urine sedimentation can be the key to directing the diagnosis." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-28" "fechaAceptado" => "2018-10-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Tornero Romero F, Cabello Clotet N, Núñez Orantos MJ. Fracaso renal atípico. 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