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Sulfadiazine-Induced Obstructive Nephropathy Presenting with Upper Urinary Tract Extravasation

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Obstructive nephropathy is an uncommon side effect of sulfadiazine, which is used for the treatment of toxoplasmosis. We present a case of acute renal colic and urine extravasation of a patient shortly after she was started on this medication.

Case presentation:: A 31-year-old female presented with acute renal colic 2 weeks after starting treatment with sulfadiazine and pyrimethamine for ocular toxoplasmosis.

Results:: A noncontrast computed tomography revealed left hydronephrosis and fluid located around the kidney and in the left gutter. There were no urinary stones. Administration of intravenous contrast revealed significant urine extravasation at the level of the ureteropelvic junction. Intravenous contrast injection confirmed that the extravasation consisted of urine leakage at the ureteropelvic junction. Her clinical condition improved with the insertion of an internal stent, which was left in place for 4 weeks. A retrograde pyelography performed at the time of the internal stent removal ruled out persistent extravasation and filling defects in the left upper urinary tract. Considering the clinical circumstances and the imaging results, it appears that this is a first reported case of sulfadiazine-induced obstructive uropathy associated with urine extravasation.

Conclusion:: Although rare, obstructive uropathy related to sulfadiazine medication should be promptly suspected, diagnosed, and treated. Patients should be instructed to substantially increase their liquid intake while on that medication.

No MeSH data available.


Related in: MedlinePlus

Coronal reconstruction of a computerized tomographic urography showing bilateral renal excretion with left hydronephrosis and urine extravasation from the ureteropelvic junction site.
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f1: Coronal reconstruction of a computerized tomographic urography showing bilateral renal excretion with left hydronephrosis and urine extravasation from the ureteropelvic junction site.

Mentions: A 31-year-old female patient presented to the emergency room with left renal colic. She appeared to be in considerable distress associated with bouts of excruciating left flank pain, nausea, and vomiting. The patient was afebrile, her blood pressure within normal limits, and her heart rate was 80 beats per minute. Physical examination revealed severe left flank and abdominal tenderness without signs of peritonitis. Her laboratory test results were hemoglobin 13.4 g/dL, leukocytosis 16.100/mm3, mild renal failure with a creatinine level of 1.2 mg/dL, and microhematuria without signs of infection in the urinalysis. Administration of intravenous crystalloids, opioid, and antiemetic medications led to some clinical improvement. A low radiation protocol of noncontrast computed tomography (NCCT) of the abdomen revealed left hydronephrosis with perinephric-free fluid and accumulation of fluid in the left gutter. There were no urinary stones. To further clarify these findings, intravenous contrast was administered 3 hours later and the NCCT was completed with a computerized tomographic urography showing bilateral symmetrical renal excretion with left hydronephrosis and retroperitoneal urinary extravasation originating at the level of the left ureteropelvic junction (Fig. 1). In light of the severe extravasation and the extent of the patient's pain, we decided to drain the left kidney by means of a 7FR internal stent.


Sulfadiazine-Induced Obstructive Nephropathy Presenting with Upper Urinary Tract Extravasation
Coronal reconstruction of a computerized tomographic urography showing bilateral renal excretion with left hydronephrosis and urine extravasation from the ureteropelvic junction site.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5035827&req=5

f1: Coronal reconstruction of a computerized tomographic urography showing bilateral renal excretion with left hydronephrosis and urine extravasation from the ureteropelvic junction site.
Mentions: A 31-year-old female patient presented to the emergency room with left renal colic. She appeared to be in considerable distress associated with bouts of excruciating left flank pain, nausea, and vomiting. The patient was afebrile, her blood pressure within normal limits, and her heart rate was 80 beats per minute. Physical examination revealed severe left flank and abdominal tenderness without signs of peritonitis. Her laboratory test results were hemoglobin 13.4 g/dL, leukocytosis 16.100/mm3, mild renal failure with a creatinine level of 1.2 mg/dL, and microhematuria without signs of infection in the urinalysis. Administration of intravenous crystalloids, opioid, and antiemetic medications led to some clinical improvement. A low radiation protocol of noncontrast computed tomography (NCCT) of the abdomen revealed left hydronephrosis with perinephric-free fluid and accumulation of fluid in the left gutter. There were no urinary stones. To further clarify these findings, intravenous contrast was administered 3 hours later and the NCCT was completed with a computerized tomographic urography showing bilateral symmetrical renal excretion with left hydronephrosis and retroperitoneal urinary extravasation originating at the level of the left ureteropelvic junction (Fig. 1). In light of the severe extravasation and the extent of the patient's pain, we decided to drain the left kidney by means of a 7FR internal stent.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Obstructive nephropathy is an uncommon side effect of sulfadiazine, which is used for the treatment of toxoplasmosis. We present a case of acute renal colic and urine extravasation of a patient shortly after she was started on this medication.

Case presentation:: A 31-year-old female presented with acute renal colic 2 weeks after starting treatment with sulfadiazine and pyrimethamine for ocular toxoplasmosis.

Results:: A noncontrast computed tomography revealed left hydronephrosis and fluid located around the kidney and in the left gutter. There were no urinary stones. Administration of intravenous contrast revealed significant urine extravasation at the level of the ureteropelvic junction. Intravenous contrast injection confirmed that the extravasation consisted of urine leakage at the ureteropelvic junction. Her clinical condition improved with the insertion of an internal stent, which was left in place for 4 weeks. A retrograde pyelography performed at the time of the internal stent removal ruled out persistent extravasation and filling defects in the left upper urinary tract. Considering the clinical circumstances and the imaging results, it appears that this is a first reported case of sulfadiazine-induced obstructive uropathy associated with urine extravasation.

Conclusion:: Although rare, obstructive uropathy related to sulfadiazine medication should be promptly suspected, diagnosed, and treated. Patients should be instructed to substantially increase their liquid intake while on that medication.

No MeSH data available.


Related in: MedlinePlus