array:21 [
  "pii" => "S2013251424001901"
  "issn" => "20132514"
  "doi" => "10.1016/j.nefroe.2024.10.008"
  "estado" => "S200"
  "fechaPublicacion" => "2024-10-31"
  "aid" => "1253"
  "copyrightAnyo" => "2024"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "cor"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0211699524000286"
      "issn" => "02116995"
      "doi" => "10.1016/j.nefro.2024.03.006"
      "estado" => "S300"
      "fechaPublicacion" => "2024-09-01"
      "aid" => "1253"
      "copyright" => "Sociedad Española de Nefrología"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Nefrologia. 2024;44:755-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>"
        "titulo" => "Alogliptina y nefritis tubulointersticial&#58; una complicaci&#243;n potencial"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "755"
            "paginaFinal" => "757"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Alogliptin and tubulointerstitial nephritis&#58; A potential complication"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 537
                "Ancho" => 755
                "Tamanyo" => 152336
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En el intersticio se identifica prominente infiltrado inflamatorio polimorfo&#44; constituido por abundantes leucocitos polimorfonucleares&#44; linfocitos&#44; c&#233;lulas plasm&#225;ticas y ocasionales eosin&#243;filos con im&#225;genes de tubulitis&#46; Par&#233;nquima renal con datos morfol&#243;gicos compatibles con una nefropat&#237;a intersticial aguda y necrosis tubular aguda con cambios regenerativos&#46; Tinci&#243;n PAS &#40;&#225;cido pery&#243;dico de Schiff&#41;&#44; &#215;400&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Byron Chiliquinga Morales, Carmen Martin Varas, Leonardo Calle Garcia, Astrid Rodr&#237;guez G&#243;mez, Carlos Santos Alonso, Pablo S&#225;nchez Garrote, Paulo Garcia Gutierrez, Nieves Losada de la Rosa, Mar&#237;a Jos&#233; Fern&#225;ndez-Reyes Luis, Ana Saiz Gonz&#225;lez, Angie Tenelanda Santillan"
            "autores" => array:11 [
              0 => array:2 [
                "nombre" => "Byron"
                "apellidos" => "Chiliquinga Morales"
              ]
              1 => array:2 [
                "nombre" => "Carmen"
                "apellidos" => "Martin Varas"
              ]
              2 => array:2 [
                "nombre" => "Leonardo"
                "apellidos" => "Calle Garcia"
              ]
              3 => array:2 [
                "nombre" => "Astrid"
                "apellidos" => "Rodr&#237;guez G&#243;mez"
              ]
              4 => array:2 [
                "nombre" => "Carlos"
                "apellidos" => "Santos Alonso"
              ]
              5 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "S&#225;nchez Garrote"
              ]
              6 => array:2 [
                "nombre" => "Paulo"
                "apellidos" => "Garcia Gutierrez"
              ]
              7 => array:2 [
                "nombre" => "Nieves"
                "apellidos" => "Losada de la Rosa"
              ]
              8 => array:2 [
                "nombre" => "Mar&#237;a Jos&#233;"
                "apellidos" => "Fern&#225;ndez-Reyes Luis"
              ]
              9 => array:2 [
                "nombre" => "Ana Saiz"
                "apellidos" => "Gonz&#225;lez"
              ]
              10 => array:2 [
                "nombre" => "Angie"
                "apellidos" => "Tenelanda Santillan"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2013251424001901"
          "doi" => "10.1016/j.nefroe.2024.10.008"
          "estado" => "S200"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251424001901?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699524000286?idApp=UINPBA000064"
      "url" => "/02116995/0000004400000005/v1_202409110539/S0211699524000286/v1_202409110539/es/main.assets"
    ]
  ]
  "itemAnterior" => array:18 [
    "pii" => "S201325142300024X"
    "issn" => "20132514"
    "doi" => "10.1016/j.nefroe.2023.02.001"
    "estado" => "S200"
    "fechaPublicacion" => "2023-02-27"
    "aid" => "5004"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "err"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Erratum</span>"
      "titulo" => "Erratum to &#8220;Recommendations for living donor kidney transplantation&#8221;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fe de errores de &#8220;Recomendaciones para el trasplante renal de donante vivo&#8221;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Miguel &#193;ngel Frutos, Marta Crespo, Mar&#237;a de la Oliva Valent&#237;n, &#193;ngel Alonso-Melgar, Juana Alonso, Constantino Fern&#225;ndez, Gorka Garc&#237;a-Erauzkin, Esther Gonz&#225;lez, Ana M&#46; Gonz&#225;lez-Rinne, Lluis Guirado, Alex Guti&#233;rrez-Dalmau, Jorge Huguet, Jos&#233; Luis L&#243;pez del Moral, Mireia Musquera, David Paredes, Dolores Redondo, Ignacio Revuelta, Carlos J Van-der Hofstadt, Antonio Alcaraz, &#193;ngel Alonso-Hern&#225;ndez, Manuel Alonso, Purificaci&#243;n Bernabeu, Gabriel Bernal, Alberto Breda, Mercedes Cabello, Jos&#233; Luis Caro-Oleas, Joan Cid, Fritz Diekmann, Laura Espinosa, Carme Facundo, Marta Garc&#237;a, Salvador Gil-Vernet, Miquel Lozano, Beatriz Mahillo, Mar&#237;a Jos&#233; Mart&#237;nez, Blanca Miranda, Federico Oppenheimer, Eduard Palou, Mar&#237;a Jos&#233; P&#233;rez-Saez, Lluis Peri, Oscar Rodr&#237;guez, Carlos Santiago, Guadalupe Tabernero, Domingo Hern&#225;ndez, Beatriz Dom&#237;nguez-Gil, Julio Pascual"
          "autores" => array:46 [
            0 => array:2 [
              "nombre" => "Miguel &#193;ngel"
              "apellidos" => "Frutos"
            ]
            1 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Crespo"
            ]
            2 => array:2 [
              "nombre" => "Mar&#237;a de la Oliva"
              "apellidos" => "Valent&#237;n"
            ]
            3 => array:2 [
              "nombre" => "&#193;ngel"
              "apellidos" => "Alonso-Melgar"
            ]
            4 => array:2 [
              "nombre" => "Juana"
              "apellidos" => "Alonso"
            ]
            5 => array:2 [
              "nombre" => "Constantino"
              "apellidos" => "Fern&#225;ndez"
            ]
            6 => array:2 [
              "nombre" => "Gorka"
              "apellidos" => "Garc&#237;a-Erauzkin"
            ]
            7 => array:2 [
              "nombre" => "Esther"
              "apellidos" => "Gonz&#225;lez"
            ]
            8 => array:2 [
              "nombre" => "Ana M&#46;"
              "apellidos" => "Gonz&#225;lez-Rinne"
            ]
            9 => array:2 [
              "nombre" => "Lluis"
              "apellidos" => "Guirado"
            ]
            10 => array:2 [
              "nombre" => "Alex"
              "apellidos" => "Guti&#233;rrez-Dalmau"
            ]
            11 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Huguet"
            ]
            12 => array:2 [
              "nombre" => "Jos&#233; Luis L&#243;pez del"
              "apellidos" => "Moral"
            ]
            13 => array:2 [
              "nombre" => "Mireia"
              "apellidos" => "Musquera"
            ]
            14 => array:2 [
              "nombre" => "David"
              "apellidos" => "Paredes"
            ]
            15 => array:2 [
              "nombre" => "Dolores"
              "apellidos" => "Redondo"
            ]
            16 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "Revuelta"
            ]
            17 => array:2 [
              "nombre" => "Carlos J Van-der"
              "apellidos" => "Hofstadt"
            ]
            18 => array:2 [
              "nombre" => "Antonio"
              "apellidos" => "Alcaraz"
            ]
            19 => array:2 [
              "nombre" => "&#193;ngel"
              "apellidos" => "Alonso-Hern&#225;ndez"
            ]
            20 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Alonso"
            ]
            21 => array:2 [
              "nombre" => "Purificaci&#243;n"
              "apellidos" => "Bernabeu"
            ]
            22 => array:2 [
              "nombre" => "Gabriel"
              "apellidos" => "Bernal"
            ]
            23 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Breda"
            ]
            24 => array:2 [
              "nombre" => "Mercedes"
              "apellidos" => "Cabello"
            ]
            25 => array:2 [
              "nombre" => "Jos&#233; Luis"
              "apellidos" => "Caro-Oleas"
            ]
            26 => array:2 [
              "nombre" => "Joan"
              "apellidos" => "Cid"
            ]
            27 => array:2 [
              "nombre" => "Fritz"
              "apellidos" => "Diekmann"
            ]
            28 => array:2 [
              "nombre" => "Laura"
              "apellidos" => "Espinosa"
            ]
            29 => array:2 [
              "nombre" => "Carme"
              "apellidos" => "Facundo"
            ]
            30 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Garc&#237;a"
            ]
            31 => array:2 [
              "nombre" => "Salvador"
              "apellidos" => "Gil-Vernet"
            ]
            32 => array:2 [
              "nombre" => "Miquel"
              "apellidos" => "Lozano"
            ]
            33 => array:2 [
              "nombre" => "Beatriz"
              "apellidos" => "Mahillo"
            ]
            34 => array:2 [
              "nombre" => "Mar&#237;a Jos&#233;"
              "apellidos" => "Mart&#237;nez"
            ]
            35 => array:2 [
              "nombre" => "Blanca"
              "apellidos" => "Miranda"
            ]
            36 => array:2 [
              "nombre" => "Federico"
              "apellidos" => "Oppenheimer"
            ]
            37 => array:2 [
              "nombre" => "Eduard"
              "apellidos" => "Palou"
            ]
            38 => array:2 [
              "nombre" => "Mar&#237;a Jos&#233;"
              "apellidos" => "P&#233;rez-Saez"
            ]
            39 => array:2 [
              "nombre" => "Lluis"
              "apellidos" => "Peri"
            ]
            40 => array:2 [
              "nombre" => "Oscar"
              "apellidos" => "Rodr&#237;guez"
            ]
            41 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Santiago"
            ]
            42 => array:2 [
              "nombre" => "Guadalupe"
              "apellidos" => "Tabernero"
            ]
            43 => array:2 [
              "nombre" => "Domingo"
              "apellidos" => "Hern&#225;ndez"
            ]
            44 => array:2 [
              "nombre" => "Beatriz"
              "apellidos" => "Dom&#237;nguez-Gil"
            ]
            45 => array:2 [
              "nombre" => "Julio"
              "apellidos" => "Pascual"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S201325142300024X?idApp=UINPBA000064"
    "url" => "/20132514/unassign/S201325142300024X/v1_202302271724/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Alogliptin and tubulointerstitial nephritis&#58; A potential complication"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Byron Chiliquinga Morales, Carmen Martin Varas, Leonardo Calle Garc&#237;a, Astrid Rodr&#237;guez G&#243;mez, Carlos Santos Alonso, Pablo S&#225;nchez Garrote, Paulo Garc&#237;a Guti&#233;rrez, Nieves Losada de la Rosa, Mar&#237;a Jos&#233; Fern&#225;ndez-Reyes Luis, Ana Saiz Gonz&#225;lez, Angie Tenelanda Santillan"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "Byron"
            "apellidos" => "Chiliquinga Morales"
            "email" => array:1 [
              0 => "byronchm94@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Carmen"
            "apellidos" => "Martin Varas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Leonardo"
            "apellidos" => "Calle Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Astrid"
            "apellidos" => "Rodr&#237;guez G&#243;mez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Carlos"
            "apellidos" => "Santos Alonso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "S&#225;nchez Garrote"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Paulo"
            "apellidos" => "Garc&#237;a Guti&#233;rrez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Nieves"
            "apellidos" => "Losada de la Rosa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Mar&#237;a Jos&#233;"
            "apellidos" => "Fern&#225;ndez-Reyes Luis"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Ana Saiz"
            "apellidos" => "Gonz&#225;lez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Angie"
            "apellidos" => "Tenelanda Santillan"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Hospital General de Segovia&#44; Segovia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anatom&#237;a Patol&#243;gica&#44; Hospital Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Alogliptina y nefritis tubulointersticial&#58; una complicaci&#243;n potencial"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 537
            "Ancho" => 755
            "Tamanyo" => 152336
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The interstitium shows a prominent polymorphous inflammatory infiltrate consisting of abundant polymorphonuclear leucocytes&#44; lymphocytes&#44; plasma cells and occasional eosinophils with images of tubulitis&#46; Renal parenchyma with morphological data consistent with acute interstitial nephropathy and acute tubular necrosis with regenerative changes&#46; PAS &#40;periodic acid-schiff&#41; stain&#44; &#215;400&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Alogliptin is one of the dipeptidyl-peptidase 4 &#40;DPP4&#41; inhibitors used in the treatment of type 2 diabetes mellitus&#46; Acute pancreatitis&#44; as well as hypersensitivity reactions and allergic reactions such as rash or pruritus have been reported as side effects&#46; However&#44; there are very few reported cases of renal adverse effects&#46; Renal adverse reactions include isolated cases of acute interstitial nephritis associated with DPP4 inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 57-year-old female patient with a history of type 2 diabetes mellitus&#44; being evaluated in the outpatient internal medicine department for constitutional syndrome of one and a half month duration&#46; She was urgently admitted to the nephrology department after detecting creatinine levels of 5&#46;1&#8239;mg&#47;dl in a blood test carried out prior to the consultation&#46; The patient exhibited no cardiovascular symptoms and was haemodynamically stable with a tendency to hypertension&#44; 160&#47;80&#8239;mmHg&#44; heart rate 96&#8239;bpm and normal blood volume&#46; In the Emergency room&#44; impairement of renal function was confirmed&#44; with potassium 4&#46;6&#8239;mmol&#47;l&#44; sodium 138&#46;6&#8239;mmol&#47;l&#44; pH 7&#46;27&#44; bicarbonate 18&#46;4&#8239;mmol&#47;l&#44; pCO<span class="elsevierStyleInf">2</span> 40&#8239;mmHg and lactate 0&#46;9&#8239;mmol&#47;l&#46; The patient&#8217;s urinalysis and urinary sediment were normal&#44; with proteinuria of less than 0&#46;3&#8239;g&#47;24&#8239;h&#44; suggestive of tubulointerstitial damage&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Investigation of impaired renal function &#40;autoimmunity&#44; serology&#44; complement and immunoglobulins&#41; was extended and all were negative&#46; Renal biopsy confirmed morphological data consistent with acute tubulointerstitial nephropathy and acute tubular necrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; With these findings&#44; pulses of 250&#8239;mg methylprednisolone were started for three days followed by oral prednisone at a tapering dose of 1&#8239;mg&#47;kg&#46; After ruling out other possible causes of tubulointerstitial nephritis and conducting a thorough review of the patient&#8217;s usual medication&#44; we were able to relate the onset of symptoms and impaired renal function to the start of treatment with alogliptin&#46; After starting corticosteroid therapy and discontinuing alogliptin&#44; the patient&#8217;s renal function progressively improved&#44; with Cr 2&#46;5&#8239;mg&#47;dl upon hospital discharge&#46; She is currently on outpatient follow-up at our clinic&#59; renal function has been restored to previous values&#44; recording 1&#46;2&#8239;mg&#47;dl at the last creatinine check &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; We classified this adverse drug reaction as probable&#44; according to the WHO causality criteria&#44; as it had a reasonable time relationship between the clinical manifestations and drug intake&#44; could not be attributed to other causes or medications&#44; and responded favourably to drug withdrawal&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In our patient&#8217;s case&#44; the clinical presentation of tubulointerstitial nephritis was not classic&#44; as she did not have skin rash&#44; eosinophilia or joint pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Our patient&#8217;s condition began with rapidly progressive renal failure accompanied by weight loss and asthenia&#46; Other diseases and recent medication that could have triggered the condition were ruled out&#44; with the most likely cause of tubulointerstitial nephritis being the initiation of alogliptin as an oral antidiabetic agent&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Reviewing the literature&#44; there are very few reported cases of adverse reactions to alogliptin compared to other DPP4 inhibitors&#44; such as sitagliptin&#46; Evidence supports starting corticosteroid therapy when renal function does not improve despite drug withdrawal and while awaiting renal biopsy results&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> In our case&#44; given the severity of the patient&#8217;s renal failure&#44; it was decided to start corticosteroid therapy early<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> after withdrawal of alogliptin and until the result was confirmed by the renal biopsy report&#46; As a result&#44; the patient experienced a marked clinical improvement and her renal function returned to its previous values&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given that this is a rarely described adverse reaction and that these are commonly-used drugs&#44; we believe it is important to consider the involvement of these drugs in patients presenting with acute renal failure in relation to tubulointerstitial nephritis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 537
            "Ancho" => 755
            "Tamanyo" => 152336
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The interstitium shows a prominent polymorphous inflammatory infiltrate consisting of abundant polymorphonuclear leucocytes&#44; lymphocytes&#44; plasma cells and occasional eosinophils with images of tubulitis&#46; Renal parenchyma with morphological data consistent with acute interstitial nephropathy and acute tubular necrosis with regenerative changes&#46; PAS &#40;periodic acid-schiff&#41; stain&#44; &#215;400&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The table shows changes in the patient&#8217;s renal function and treatment received in chronological order&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Creatinine &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">December 2022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alogliptin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">May 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alogliptin discontinued&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone 250&#8239;mg IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">June 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone 1&#8239;mg&#47;kg PO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">July 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3708962.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Changes in renal function&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rare allergic reaction of the kidney&#58; sitagliptin-induced acute tubulointerstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;A&#46; Alsaad"
                            1 => "S&#46;M&#46; Dhannoon"
                            2 => "S&#46;-A&#46;L&#46; Pantin"
                            3 => "I&#46;E&#46; Porter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2016-216297"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ Case Rep"
                        "fecha" => "2016"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alogliptin-induced minimal change nephrotic syndrome and interstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Shima"
                            1 => "T&#46; Okamoto"
                            2 => "M&#46; Tashiro"
                            3 => "T&#46; Inoue"
                            4 => "C&#46; Masaki"
                            5 => "H&#46; Tada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.xkme.2019.03.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Med"
                        "fecha" => "2019"
                        "volumen" => "1"
                        "paginaInicial" => "75"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32734188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tubulointerstitial nephritis after using a sodium-glucose cotransporter 2 inhibitor"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Konta"
                            1 => "E&#46; Saito"
                            2 => "K&#46; Sato"
                            3 => "K&#46; Furuta"
                            4 => "K&#46; Miyauchi"
                            5 => "A&#46; Furukawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.9011-21"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2022"
                        "volumen" => "61"
                        "paginaInicial" => "3239"
                        "paginaFinal" => "3243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35283386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Author&#8217;s reply&#58; detailed causality between sodium-glucose cotransporter 2 inhibitor and tubulointerstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Konta"
                            1 => "E&#46; Saito"
                            2 => "K&#46; Sato"
                            3 => "K&#46; Furuta"
                            4 => "K&#46; Miyauchi"
                            5 => "A&#46; Furukawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.0341-22"
                      "Revista" => array:5 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2023"
                        "volumen" => "62"
                        "paginaInicial" => "819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35871589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.2169/internalmedicine.0341-22"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;35871589&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alogliptin&#58; a new dipeptidyl peptidase-4 inhibitor for type 2 diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;I&#46; Jarvis"
                            1 => "A&#46; Cabrera"
                            2 => "D&#46; Charron"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1060028013504076"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Pharmacother"
                        "fecha" => "2013"
                        "volumen" => "47"
                        "paginaInicial" => "1532"
                        "paginaFinal" => "1539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24285765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alogliptin &#40;Nesina&#41; for adults with type-2 diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Dineen"
                            1 => "C&#46; Law"
                            2 => "R&#46; Scher"
                            3 => "E&#46; Pyon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Pharmacy Ther"
                        "fecha" => "2014"
                        "volumen" => "39"
                        "paginaInicial" => "186"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The changing profile of acute tubulointerstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;J&#46; Baker"
                            1 => "C&#46;D&#46; Pusey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfg464"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "8"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14671029"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1093/ndt/gfg464"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;14671029&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute kidney injury events in patients with type 2 diabetes using SGLT2 inhibitors versus other glucose-lowering drugs&#58; a retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Rampersad"
                            1 => "E&#46; Kraut"
                            2 => "R&#46;H&#46; Whitlock"
                            3 => "P&#46; Komenda"
                            4 => "V&#46; Woo"
                            5 => "C&#46; Rigatto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1053/j.ajkd.2020.03.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis"
                        "fecha" => "2020"
                        "volumen" => "76"
                        "paginaInicial" => "471"
                        "paginaFinal" => "479&#46;e1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32464161"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1053/j.ajkd.2020.03.019"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;32464161&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The outcome of acute interstitial nephritis&#58; risk factors for the transition from acute to chronic interstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Schwarz"
                            1 => "P&#46;H&#46; Krause"
                            2 => "U&#46; Kunzendorf"
                            3 => "F&#46; Keller"
                            4 => "A&#46; Distler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nephrol"
                        "fecha" => "2000"
                        "volumen" => "54"
                        "paginaInicial" => "179"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11020015"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;11020015&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Gonz&#225;lez"
                            1 => "E&#46; Guti&#233;rrez"
                            2 => "C&#46; Galeano"
                            3 => "C&#46; Chevia"
                            4 => "P&#46; de Sequera"
                            5 => "C&#46; Bernis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ki.5002776"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2008"
                        "volumen" => "73"
                        "paginaInicial" => "940"
                        "paginaFinal" => "946"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18185501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/sj.ki.5002776"
                      "WWW" => array:1 [
                        "link" => "https&#58;&#47;&#47;pubmed&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;18185501&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/unassign/S2013251424001901/v1_202410310611/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/20132514/unassign/S2013251424001901/v1_202410310611/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251424001901?idApp=UINPBA000064"
]
Share
Journal Information
Letter to the Editor
Full text access
Available online 31 October 2024
Alogliptin and tubulointerstitial nephritis: A potential complication
Alogliptina y nefritis tubulointersticial: una complicación potencial
Visits
60
Byron Chiliquinga Moralesa,
Corresponding author
byronchm94@gmail.com

Corresponding author.
, Carmen Martin Varasa, Leonardo Calle Garcíaa, Astrid Rodríguez Gómeza, Carlos Santos Alonsoa, Pablo Sánchez Garrotea, Paulo García Gutiérreza, Nieves Losada de la Rosaa, María José Fernández-Reyes Luisa, Ana Saiz Gonzálezb, Angie Tenelanda Santillanb
a Servicio de Nefrología, Hospital General de Segovia, Segovia, Spain
b Servicio de Anatomía Patológica, Hospital Ramón y Cajal, Madrid, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (1)
Table 1. Changes in renal function.
Full Text
Dear Editor,

Alogliptin is one of the dipeptidyl-peptidase 4 (DPP4) inhibitors used in the treatment of type 2 diabetes mellitus. Acute pancreatitis, as well as hypersensitivity reactions and allergic reactions such as rash or pruritus have been reported as side effects. However, there are very few reported cases of renal adverse effects. Renal adverse reactions include isolated cases of acute interstitial nephritis associated with DPP4 inhibitors.1,2

We present the case of a 57-year-old female patient with a history of type 2 diabetes mellitus, being evaluated in the outpatient internal medicine department for constitutional syndrome of one and a half month duration. She was urgently admitted to the nephrology department after detecting creatinine levels of 5.1 mg/dl in a blood test carried out prior to the consultation. The patient exhibited no cardiovascular symptoms and was haemodynamically stable with a tendency to hypertension, 160/80 mmHg, heart rate 96 bpm and normal blood volume. In the Emergency room, impairement of renal function was confirmed, with potassium 4.6 mmol/l, sodium 138.6 mmol/l, pH 7.27, bicarbonate 18.4 mmol/l, pCO2 40 mmHg and lactate 0.9 mmol/l. The patient’s urinalysis and urinary sediment were normal, with proteinuria of less than 0.3 g/24 h, suggestive of tubulointerstitial damage.

Investigation of impaired renal function (autoimmunity, serology, complement and immunoglobulins) was extended and all were negative. Renal biopsy confirmed morphological data consistent with acute tubulointerstitial nephropathy and acute tubular necrosis (Fig. 1). With these findings, pulses of 250 mg methylprednisolone were started for three days followed by oral prednisone at a tapering dose of 1 mg/kg. After ruling out other possible causes of tubulointerstitial nephritis and conducting a thorough review of the patient’s usual medication, we were able to relate the onset of symptoms and impaired renal function to the start of treatment with alogliptin. After starting corticosteroid therapy and discontinuing alogliptin, the patient’s renal function progressively improved, with Cr 2.5 mg/dl upon hospital discharge. She is currently on outpatient follow-up at our clinic; renal function has been restored to previous values, recording 1.2 mg/dl at the last creatinine check (Table 1). We classified this adverse drug reaction as probable, according to the WHO causality criteria, as it had a reasonable time relationship between the clinical manifestations and drug intake, could not be attributed to other causes or medications, and responded favourably to drug withdrawal.

Fig. 1.

The interstitium shows a prominent polymorphous inflammatory infiltrate consisting of abundant polymorphonuclear leucocytes, lymphocytes, plasma cells and occasional eosinophils with images of tubulitis. Renal parenchyma with morphological data consistent with acute interstitial nephropathy and acute tubular necrosis with regenerative changes. PAS (periodic acid-schiff) stain, ×400.

(0.15MB).
Table 1.

Changes in renal function.

Month  Creatinine (mg/dl)  Treatment 
December 2022  0.60   
February 2023  1.2  Alogliptin 
March 2023  1.8   
May 2023  5.1  Alogliptin discontinued 
    Methylprednisolone 250 mg IV 
June 2023  1.9  Prednisone 1 mg/kg PO 
July 2023  1.5   
October 2023  1.2   

The table shows changes in the patient’s renal function and treatment received in chronological order.

In our patient’s case, the clinical presentation of tubulointerstitial nephritis was not classic, as she did not have skin rash, eosinophilia or joint pain.3–5 Our patient’s condition began with rapidly progressive renal failure accompanied by weight loss and asthenia. Other diseases and recent medication that could have triggered the condition were ruled out, with the most likely cause of tubulointerstitial nephritis being the initiation of alogliptin as an oral antidiabetic agent.5,6

Reviewing the literature, there are very few reported cases of adverse reactions to alogliptin compared to other DPP4 inhibitors, such as sitagliptin. Evidence supports starting corticosteroid therapy when renal function does not improve despite drug withdrawal and while awaiting renal biopsy results.5–7 In our case, given the severity of the patient’s renal failure, it was decided to start corticosteroid therapy early8,9 after withdrawal of alogliptin and until the result was confirmed by the renal biopsy report. As a result, the patient experienced a marked clinical improvement and her renal function returned to its previous values.

Given that this is a rarely described adverse reaction and that these are commonly-used drugs, we believe it is important to consider the involvement of these drugs in patients presenting with acute renal failure in relation to tubulointerstitial nephritis.10

References
[1]
A.A. Alsaad, S.M. Dhannoon, S.-A.L. Pantin, I.E. Porter.
Rare allergic reaction of the kidney: sitagliptin-induced acute tubulointerstitial nephritis.
BMJ Case Rep, (2016), pp. 1-3
[2]
H. Shima, T. Okamoto, M. Tashiro, T. Inoue, C. Masaki, H. Tada, et al.
Alogliptin-induced minimal change nephrotic syndrome and interstitial nephritis.
Kidney Med, 1 (2019), pp. 75-78
[3]
Y. Konta, E. Saito, K. Sato, K. Furuta, K. Miyauchi, A. Furukawa, et al.
Tubulointerstitial nephritis after using a sodium-glucose cotransporter 2 inhibitor.
Intern Med, 61 (2022), pp. 3239-3243
[4]
Y. Konta, E. Saito, K. Sato, K. Furuta, K. Miyauchi, A. Furukawa, et al.
Author’s reply: detailed causality between sodium-glucose cotransporter 2 inhibitor and tubulointerstitial nephritis.
[5]
C.I. Jarvis, A. Cabrera, D. Charron.
Alogliptin: a new dipeptidyl peptidase-4 inhibitor for type 2 diabetes mellitus.
Ann Pharmacother, 47 (2013), pp. 1532-1539
[6]
L. Dineen, C. Law, R. Scher, E. Pyon.
Alogliptin (Nesina) for adults with type-2 diabetes.
Pharmacy Ther, 39 (2014), pp. 186
[7]
R.J. Baker, C.D. Pusey.
The changing profile of acute tubulointerstitial nephritis.
[8]
C. Rampersad, E. Kraut, R.H. Whitlock, P. Komenda, V. Woo, C. Rigatto, et al.
Acute kidney injury events in patients with type 2 diabetes using SGLT2 inhibitors versus other glucose-lowering drugs: a retrospective cohort study.
[9]
A. Schwarz, P.H. Krause, U. Kunzendorf, F. Keller, A. Distler.
The outcome of acute interstitial nephritis: risk factors for the transition from acute to chronic interstitial nephritis.
Clin Nephrol, 54 (2000), pp. 179-190
[10]
E. González, E. Gutiérrez, C. Galeano, C. Chevia, P. de Sequera, C. Bernis, et al.
Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis.
Download PDF
Idiomas
Nefrología (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?