ABSTRACT
Acute interstitial nephritis due to Dyazide therapy, ie, a combination of hydrochlorothiazide (25 mg) and triamterene (50 mg), has been recently reported in the literature. This had been characterized by nonoliguric renal failure after a long latent period (weeks) following exposure to the drug. Pathologic data have indicated a drug-induced hypersensitivity reaction. We report here one case of oliguric acute renal failure after a massive Dyazide intoxication. Based on the results of the renal biopsy and clinical course, we propose that the oliguria was secondary to a direct toxic effect on the tubules, and intrarenal obstruction was secondary to triamterene crystals and crystal-laden cells. In addition, pathologic findings also suggested a moderate hypersensitivity reaction. After hemodialysis and short-term steroid therapy, the patient achieved complete recovery of renal function within 12 days. Recent knowledge of triamterene-induced nephrolithiasis helps to explain the pathogenesis of acute renal failure in this patient, and is briefly reviewed here.
Subject(s)
Acute Kidney Injury/chemically induced , Hydrochlorothiazide/poisoning , Kidney/pathology , Triamterene/poisoning , Acute Kidney Injury/pathology , Adult , Biopsy , Crystallization , Drug Combinations/poisoning , Female , Humans , Suicide, Attempted , Triamterene/metabolismSubject(s)
Poisoning/etiology , Suicide, Attempted , Antitussive Agents/poisoning , Diazepam/poisoning , Humans , Hydrochlorothiazide/poisoning , Insulin/poisoning , Male , Medazepam/poisoning , Medigoxin/poisoning , Middle Aged , Phenylbutyrates/poisoning , Triamterene/poisoning , Verapamil/poisoningABSTRACT
Daily treatment of rats with 2,4,7-triamino-6-phenylpteridine (triamterene, Dyrenium) a potassium sparing diuretic, in daly doses of 1.5 mg, 3 mg and 4.5 mg/100 g body weight over the period of three weeks caused severe degenerative changes of renal cortical and medullary tubules resembling osmotic (sucrose) nephrosis. The undesirable side-effects were absent in the kidneys of intact rats receiving human therapeutic dose of triamterene (0.36 mg/100 g body weight) and even higher dose (1.5 mg/100 g body weight) but administered according to the prescription of treatment recommended by the manufacturer--daily over the first week and three times weekly after that. Rats .2 days after adrenalectomy administered triamterene in daily dose of 1.5 mg/100 g body weight, survived no more than 6--7 days of treatment. The results presented in this paper undoubtedly show that triamterene, although a mild diuretic agent, should be monitored in order to avoid undesirable side-effects. In addition care should be taken in patients with hypofunction of adrenal cortex.
