Rodrigues M L, Costa R S, Souza C S, Foss N T, Roselino A M
Division of Dermatology, Faculty of Medicine of Ribeirão Preto, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 1999 Jan-Feb;41(1):33-7. doi: 10.1590/s0036-46651999000100007.
Pentavalent antimonials have became of basic importance for the treatment of leishmaniasis. Their most severe side effects have been reported to be increased hepatic enzyme levels and electrocardiographic abnormalities. Nephrotoxicity has been rarely related.
We report a case of generalized cutaneous leishmaniasis involving a 50-year old male patient who was submitted to treatment with meglumine antimoniate (Glucantime). He developed acute renal failure (ARF) due to acute tubular necrosis (ATN), followed by death after receiving a total of 53 ampoules of Glucantime.
The treatment with Glucantime was responsible by ARF diagnosed in this patient. The previous urine osmolarity and serum creatinine levels were normal and the autopsy showed ATN. It should be pointed out if ARF may also be explained by massive deposits of immunocomplexes by leishmania antibodies and antigens due to the antigenic break by the antimonial compound, since our patient presented countless lesions covering the entire tegument, similar to the Hexheimer phenomenon, but at the autopsy no glomerular alterations were seen.
五价锑剂已成为治疗利什曼病的重要基础药物。据报道，其最严重的副作用是肝酶水平升高和心电图异常。肾毒性很少见。
我们报告一例50岁男性全身性皮肤利什曼病患者，接受葡甲胺锑酸盐（葡糖胺锑）治疗。他因急性肾小管坏死（ATN）发展为急性肾衰竭（ARF），在总共接受53支葡糖胺锑治疗后死亡。
该患者诊断的急性肾衰竭由葡糖胺锑治疗引起。患者之前的尿渗透压和血清肌酐水平正常，尸检显示为急性肾小管坏死。需要指出的是，急性肾衰竭也可能是由于锑化合物导致抗原性破坏，利什曼原虫抗体和抗原形成大量免疫复合物沉积所致，因为我们的患者全身出现无数皮损，类似于赫克斯海默现象，但尸检未发现肾小球改变。
