Sulfasalazine
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Bilateral nephrolithiasis: case report A 59-year-old woman developed bilateral nephrolithiasis during treatment with sulfasalazine for ulcerative colitis. The woman had been receiving oral sulfasalazine [salazosulfapyridine] for about 30 years. Since February 2014, the dose of sulfasalazine was increased from 3000 mg/day to 4500 mg/day due to abdominal pain and bloody stools. Concurrently, she received rosuvastatin. In March 2015, she presented with gross haematuria and right lower back pain. She had pain in the right lumbar dorsum. Laboratory findings showed WBC 4900 /mm3, RBC 353 × 104/mm3, haemoglobin 10.6 g/dL and platelet count 29.4 × 104/mm3. Blood biochemical investigations showed albumin 4.2 g/dL, blood urea nitrogen (BUN) 13.0 mg/dL, creatinine 0.56 mg/dL, urinalysis 2.5 mg/dL, calcium 9.6 mg/dL and C-reactive protein 0.1 mg/dL. Urine tests revealed pH 5.5, urine specific gravity 1.024, WBC 1-4 /HPF and RBC >100 /HPF. Uric acid crystal precipitation was also noted. An abdominal X-ray did not reveal a calculus shadow. Abdominal CT scan demonstrated bilateral renal pelvic calculi. The right stone had a diameter of 18mm and the left stone a diameter of 15mm. Urinalysis showed aciduria. Uric acid crystals were suspected. Abdominal X-ray demonstrated no calculus shadows. The woman was treated with febuxostat to suppress uric acid excretion in the urine. After 3 months, abdominal CT scan showed enlargement of the bilateral renal pelvic calculi. In September 2015, she was admitted, and transurethral ureterolithotripsy was performed for the right renal pelvic stone due to exacerbation of the right low back pain. The analysis of stone showed that it was comparatively soft, orange, and chipped down until it was about half of the original size. Infrared spectroscopy showed similar infrared absorption pattern in the stone and sulfasalazine, which confirmed sulfasalazine-induced nephrolithiasis. Her sulfasalazine therapy was changed to mesalazine, and the dose of potassium citrate/sodium citrate were increased. Urine pH was maintained at 7.0-7.5. Three months later, abdominal CT scan revealed dissipation of bilateral renal pelvic calculi. Further, she did not administer any preventative medication, and no recurrence of nephrolithiasis was noted. Ogawa K, et al. DRUG-INDUCED BILATERAL NEPHROLITHIASIS IN AN ULCERATIVE COLITIS PATIENT: A CASE REPORT Nippon Hinyokika Gakkai Zasshi. 803498102 The Japanese Journal of Urology 110: 41-46, No. 1, 2019. Available from: URL: http://doi.org/10.5980/jpnjurol.110.41 [Japanese; summarised from a translation]
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Reactions 29 Aug 2020 No. 1819
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