Sulfadiazine crystalluria in a patient with lupus nephritis.

OBJECTIVES

It is estimated that 29% of patients treated with sulfadiazine ultimately develop acute kidney failure. Diagnosis is based on urine sediment analysis.

CASE PRESENTATION: A 71-year-old woman with loss of visual acuity in the context of a flare of systemic erythematosus lupus (SEL). A diagnosis of acute retinal necrosis was established, pending etiological confirmation. Empirical treatment with sulfadiazine was initiated. Follow-up analyses included urine sediment, which revealed pH 6, 30-50 RBCs/field, urothelial cells and lower tract epithelial cells, hyaline casts, fatty casts or Maltese cross, and abundant sulfadiazine crystals. The finding was reported to the Unit of Nephrology, and treatment was immediately suspended.

CONCLUSIONS

Sulfadiazine is an antibiotic of the family of sulfamides. Crystalization of sulfadiazine in the renal tubules may cause acute interstitial nephritis. These crystals adopt different shapes according to the metabolite that crystalizes: unaltered forms precipitate into dense, globular crystals, whereas in other cases, as in the case reported in this paper, crystals adopt a fan-shaped, shocks-of-wheat morphology.