Reactions 907 - 22 Jun 2002

SCarbamazepine

Interstitial nephritis in an elderly patient: casereport

A 79-year-old man developed acute granulomatousinterstitial nephritis during carbamazepine treatment forcomplex partial seizures.

The man had been receiving carbamazepine 100mg twicedaily for 2 weeks when he presented with an erythematousrash. The rash had started on his feet 2 days after the initiationof carbamazepine, and had spread up his legs. A blood countat this time revealed eosinophilia at 1.5 × 109/L. Hisconcomitant medication was discontinued and hiscarbamazepine dosage was increased to 200mg twice daily.Two weeks later, his rash had worsened and he was admittedto hospital; carbamazepine was discontinued. Examinationshowed increased eosinophilia (2.4 × 109/L), elevated levels oftotal bilirubin (36 µmol/L), globulin (22 g/L), alkalinephosphatase (881 U/L) and ALT (391 U/L). Six days aftercarbamazepine was discontinued his liver function hadimproved. However, he had acute renal failure with a urealevel of 39.5 mmol/L, a creatinine level of 846 µmol/L, sodium,potassium, corrected calcium, and phosphate levels of 133,4.2, 1.86 and 2.27 mmol/L, respectively, and an albumin levelof 29 g/L; he also had a further increase in his eosinophilia to7.92 × 109/L. He developed signs of fluid overload and wasanuric. He underwent haemodialysis and treatment withcorticosteroids was started. A renal biopsy revealed markedinterstitial oedema, and a granulomatous appearance in someareas. Haemodialysis was continued for 4 days, and his urineoutput increased.

The man was discharged on hospital day 15 takingprednisolone, which was gradually tapered then stopped over7 weeks. At 4 months’ follow-up, his renal and liver functionhad completely recovered.Hegarty J, et al. Carbamazepine-induced acute granulomatous interstitial nephritis.Clinical Nephrology 57: 310-313, Apr 2002 - England 800908597

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Reactions 22 Jun 2002 No. 9070114-9954/10/0907-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved