Urolithiasis as a Hazard of Sulfonamide Therapy

Albala, David; Prien, Edwin L.; Galal, Hussein

doi:10.1089/end.1994.8.401

Cited by 34 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this indication, sulfadiazine is used at very large doses (4-8 g/day), thus resulting in heavy crystalluria, especially if urine pH and urine output are low. [53][54][55] Stones formed in sulfadiazinetreated patients are mostly made of N-acetyl-sulfadiazine (Fig. 19.2a), present in the nucleus of 93% of stones in our patients.…”

Section: Sulfonamidesmentioning

confidence: 59%

“…Sulfamethoxazole, a component of the antibacterial agent cotrimoxazole, induces frequent crystalluria but infrequently results in nephrolithiasis. 53,58 In the study by Albala et al, N-acetylsulfamethoxazole was the main component of such stones. Crystals of N-acetylsulfamethoxazole are of small size and of round or losangic shape, and are thus easily passed in urine.…”

Section: Sulfonamidesmentioning

confidence: 99%

“…Crystals of N-acetylsulfamethoxazole are of small size and of round or losangic shape, and are thus easily passed in urine. 53 This likely explains why stone formation is infrequent despite the wide use of this antibacterial agent. 1 Fortunately, sulfonamides are highly soluble in alkaline urine.…”

Section: Sulfonamidesmentioning

confidence: 99%

See 2 more Smart Citations

Drug-Induced Renal Stones

Daudon

Jungers²

2010

Urinary Tract Stone Disease

View full text Add to dashboard Cite

Drug-induced stones represent about 1% of all renal stones. They involve two main mechanisms. The first one includes stones made of the drug and/or its metabolites identified by X-ray diffraction or infrared spectroscopy on the basis of their specific diagrams. Nowadays, the most commonly observed ones are antiproteases (such as indinavir) used in HIV-infected patients, high-dose sulfadiazine used for the treatment of cerebral toxoplasmosis, and abuse of ephedrine/guaifenesin-containing preparations, whereas triamterene, formerly the most often involved drug, is less frequently observed. The second one includes stones of common composition, induced by the metabolic effects of the drug on urinary pH and excretion of calcium, oxalate, phosphate, citrate, uric acid, or other purines. The most frequent causes are unsupervised calcium/vitamin D supplementation and carbonic anhydrase inhibitors, including anticonvulsants (such as topiramate). Incidence of metabolically induced stones is probably underestimated, because they are of apparently usual composition and may reveal long after drug withdrawal. Formation of iatrogenic calculi is favored by high-dose or long-lasting treatments, high renal excretion and low solubility of the drug or its metabolites, low urine output or inadequate urine pH, and is especially frequent in patients with a history of stones. Better awareness of potentially lithogenic drugs may allow more efficient prevention and reduce the incidence of drug-induced nephrolithiasis.

show abstract

Section: Sulfonamidesmentioning

confidence: 59%

Section: Sulfonamidesmentioning

confidence: 99%

See 1 more Smart Citation

Drug-Induced Renal Stones

Daudon

Jungers²

2010

Urinary Tract Stone Disease

View full text Add to dashboard Cite

show abstract

“…Investigators postulate this is due to the losangic (rhomboid) shape of the N-acetylsulfamethoxazole crystals, which do not aggregate as readily [3]. However, due to its widespread use, nephrolithiasis from sulfamethoxazole is the most frequent sulfa-containing drug calculi in some case series [21]. Sulfasalazine, a mainstay in the treatment for inflammatory bowel disease and inflammatory arthritis, has rarely been associated with nephrolithiasis [22][23][24].…”

Section: Sulfonamidesmentioning

confidence: 99%

Miscellaneous Stone Types

Cutrell

Reilly

2011

Clinic Rev Bone Miner Metab

View full text Add to dashboard Cite

Drug-induced calculi and other rare stone types, such as ammonium acid urate or protein matrix stones, represent only about 2% of all renal calculi. However, the chance to easily reverse stone formation risk by discontinuing the offending drug makes identification of these entities important for clinicians. Additionally, study of these rare stone types contributes to understanding the biochemistry of stone formation. Drug-induced calculi may be classified into two groups based on the mechanism of stone formation. The first group includes drugs that provoke calculi composed of principally the drug and its metabolites. These medications tend to be poorly soluble, highly excreted in urine, and required at high dosages for long durations of therapy. Historically, sulfonamides, triamterene, and the HIV protease inhibitor indinavir were leading causes of drug-induced calculi. Uses of novel agents within these drug classes or alternative therapies have reduced the incidence attributed to these drugs, although risk from newer, commonly used medications-notably ciprofloxacin, aminopenicillins, ceftriaxone, ephedrine, and guaifenesinare increasingly being recognized. Microscopic analysis for crystalluria or infrared spectroscopy of collected stones aid in recognition of calculi composed primarily of a drug and its metabolites. Understanding of drug metabolism and pharmacokinetics, particularly related to effects of urine pH on drug solubility and excretion, provides a rational basis for both prevention and treatment recommendations. When possible, clinicians should avoid or exercise great caution when prescribing these medications to patients with a prior history of stones. The second group of drug-induced calculi includes drugs that cause stones due to their metabolic effects, primarily on calcium or purine metabolism. Because these calculi are identical in physical composition to the more common nephrolithiasis types, careful medication history and high clinical suspicion are required for diagnosis of these drug-induced ''metabolic'' calculi. Most drugs in this class are readily expected based on their effects on urinary calcium excretion such as calcium/Vitamin D supplements and loop diuretics. Carbonic anhydrase inhibitors, including the antiepileptics topiramate and zonisamide, are also included in this group. Ammonium acid urate stones are endemic in developing countries due to dietary limitations and recurrent diarrheal illness, but rarely occur in developed countries. Identification of these stones should raise clinical suspicion of epidemiologic risk factors including recurrent urinary tract infections with urea-splitting organisms, inflammatory bowel disease, and laxative abuse. Interestingly, these unusual clinical scenarios can recapitulate a common biochemical pathway to stone formation. Protein matrix stones are another unusual stone type associated with specific epidemiologic factors, namely recurrent urinary infections and proteinuric end-stage renal disease. Although distinctly rare, protein matrix stones ...

show abstract

“…This objective can be easily achieved by taking the advantage of facile intramolecular cyclization reactions. 5 -7 Although sulfonamides are best known as bacteriostatic 8 and antimalarial agents, 9 there is now a range of drugs, possessing very different pharmacological activities, in which the sulfonamide group is present. 10 Several of these drugs suffer from bioavailability problems or adverse secondary effects.…”

Section: Introductionmentioning

confidence: 99%

Amino acids as selective sulfonamide acylating agents

Gomes

Rodrigues

et al. 2003

Tetrahedron

View full text Add to dashboard Cite

Abstract-Acylation of antimalarial and bacteriostatic sulfonamides with N-protected amino acids and peptides was carried out using standard peptide coupling methods. These acylation reactions are regioselective for the N 4 nitrogen atom of diazine-containing sulfonamides. In contrast, only N 1 coupling was found for sulfisoxazole, an isoxazole-based sulfonamide. Computational studies suggest that a combination of geometrical, thermodynamic and electronic factors are responsible for the different reactivities reported. q

show abstract

Urolithiasis as a Hazard of Sulfonamide Therapy

Cited by 34 publications

References 7 publications

Drug-Induced Renal Stones

Drug-Induced Renal Stones

Miscellaneous Stone Types

Amino acids as selective sulfonamide acylating agents

Contact Info

Product

Resources

About