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We discuss the differential diagnosis of granulomatous interstitial nephritis and its rare association with allopurinol treatment." ] ] ] "idiomaDefecto" => "es" "url" => "/02116995/0000002600000006/v0_201502091327/X0211699506020468/v0_201502091328/es/main.assets" "Apartado" => array:4 [ "identificador" => "35352" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Casos Clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000002600000006/v0_201502091327/X0211699506020468/v0_201502091328/es/P1-E255-S135-A4394.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699506020468?idApp=UINPBA000064" ]
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NEFRITIS INTERSTICIAL GRANULOMATOSA CRONICA POR ALOPURINOL
Allopurinol-induced chronic granulomatous interstitial nephritis
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Jaume Almirall
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La trombopenia es una complicación potencial del tratamiento con heparina. Hay dos formas de trombopenia inducida por heparina (TIH). El tipo I se caracteriza por un descenso leve de las cifras de plaquetas que ocurre de 2 a 4 días después de iniciar la terapia. El recuento plaquetario suele normalizarse sin necesidad de suspender el tratamiento. El mecanismo parece relacionarse con un efecto directo de la heparina sobre la activación plaquetaria. La segunda forma (tipo II) es un desorden de carácter inmune caracterizado por trombopenia severa, que puede asociar fenómenos trombóticos arteriales y venosos. Presentamos un caso de TIH tipo II en un paciente en hemodiálisis que resultó en tromboembolismo pulmonar agudo y trombosis venosa periférica, y hacemos una revisión de la literatura.
Although drug induced interstitial nephritis is a relatively common cause of renal failure, granulomatous forms remain a rare condition. The development of a chronic granulomatous interstitial nephritis due to allopurinol is exceptional, only three cases have been described previously. We report on a patient who presented a granulomatous interstitial nephritis after 10 years of allopurinol administration (300 mg/day). At diagnosis, he had end stage renal disease and dialysis treatment was needed. Two months after drug withdrawal and on corticoid treatment a slow recovery of renal function was observed, allowing the interruption of dialysis. Two years after, the creatinine clearance is 23 ml/min, being dialysis free. We discuss the differential diagnosis of granulomatous interstitial nephritis and its rare association with allopurinol treatment.
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