Abadín J A, Durán J A, Pérez de León J A
Department of Pharmacology, Faculty of Medicine, University Hospital Virgen Macarena, Seville, Spain.
Ann Pharmacother. 1998 Jun;32(6):656-8. doi: 10.1345/aph.17254.
To describe a case of acute interstitial nephritis (AIN) probably related to administration of diltiazem.
A 53-year-old white man presented to the hospital experiencing abdominal pain radiating to both renal fossae, as well as dysuria. Diltiazem and atenolol had been prescribed to treat an episode of precordial pain associated with effort. An erythematous maculopapular rash developed approximately 2 hours after administration of a single dose of diltiazem, and acute renal failure, associated with elevated liver function test results, developed 6 days later.
To the best of our knowledge, this is the third reported case of acute renal failure believed to be induced by diltiazem. In all cases, there was an obvious temporal relationship between administration of diltiazem and the onset of acute renal failure. Previous reports failed to discuss a probable pathogenic mechanism. AIN is the most likely etiology of acute renal failure in our patient. Favorable resolution with no relapse, the presence of the skin rash, and the liver sequelae suggest a common immunoallergic mechanism.
Healthcare professionals should consider diltiazem-induced AIN in the differential diagnosis of a patient taking diltiazem who develops acute renal failure.
描述一例可能与地尔硫䓬给药相关的急性间质性肾炎（AIN）病例。
一名53岁白人男性因腹痛放射至双侧肾区及排尿困难入院。此前曾开具地尔硫䓬和阿替洛尔治疗一次与劳力相关的心前区疼痛发作。在单次服用地尔硫䓬约2小时后出现红斑丘疹性皮疹，6天后出现急性肾衰竭，并伴有肝功能检查结果升高。
据我们所知，这是第三例据信由地尔硫䓬诱发的急性肾衰竭报告病例。在所有病例中，地尔硫䓬给药与急性肾衰竭发作之间均存在明显的时间关系。既往报告未讨论可能的致病机制。AIN是我们患者急性肾衰竭最可能的病因。病情顺利缓解且无复发、皮疹的出现以及肝脏后遗症提示存在共同的免疫过敏机制。
医疗保健专业人员在对服用地尔硫䓬并发生急性肾衰竭的患者进行鉴别诊断时应考虑地尔硫䓬诱发的AIN。
