Nephritis Tubule Interstitial for Leflunomide
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Nefritis tubulo intersticial por leflunomide (Español (España))


Tubule interstitial

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Hurtado M, Barbosa Silva OR, Santacruz F. Nephritis Tubule Interstitial for Leflunomide. Rev. Colomb. Nefrol. [Internet]. 2016 Nov. 18 [cited 2023 Jan. 27];3(2):132-6. Available from:


The link between renal Tubule Interstitial Nephritis and the use of Leflunomide has not been described in the literature yet, this drug is not recognized as a nephrotoxic; therefore tracking renal function is not usually performed. We report the case of a patient admitted to the University Hospital of Clinic San Rafael by non-specific clinical symptoms and rapid deterioration of renal function. After ruling out the usual causes, we performed a renal biopsy, documenting the presence of severe tubule interstitial nephritis. By the time the use of Leflunomide was the only unusual precedent. After we suspended the treatment, the patient showed full recovery of the renal function. It is our intention to describe this case to highlight the connection between renal Tubule Interstitial Nephritis and the use of Leflunomide in order to promote keeping track of similar cases.
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1. Greene S, Watanabe K, Braatz-Trulson J. Inhibition of dihydroorotate dehydrogenase by the immunosuppressive agent leflunomide. Biochem Pharmacol. 1995; 50(6): 861-7.

2. Rückemann K, Fairbanks LD, Carrey EA, et al. Leflunomide inhibits pyrimidine de novo synthesis in mitogen-stimulated T lymphocytes from healthy humans. J Biol Chem. 1998; 273(34): 21682-91.

3. Cherwinski HM, Cohn RG, Cheung P, et al. The immunosuppressant leflunomide inhibits lymphocyte proliferation by inhibiting pyrimidine biosynthesis. J Pharmacol Exp Ther. 1995; 275(2): 1043-9.

4. Williamson RA, Yea CM, Robson PA, et al. Dihydroorotate dehydrogenase is a target. Transplant Proc. 1996; 28(6): 3088-91.

5. RI F. Mechanism of action of leflunomide in rheumatoid arthritis. J Rheumatol. 1998; 25(53): 20-6.

6. Xu X, Williams JW, Bremer EG, Finnegan A CA. Inhibition of protein tyrosine phosphorylation in T cells by a novel immunosuppressive agent, leflunomide. J Bio Chem. 1995; 270: 12398-12403.

7. Siemasko KF, Chong AS.F, Williams JW, et al. Regulation of B cell function by the immunosuppressive agent leflunomide. Trasplantation. 1996; 61: 35-641.

8. Kraan MC, Reece RJ, Barg EC, et al. Expression of ICAM-1 and MP-1 in rheumatoid synovial tissue after treatment with leflunomide or methotrexate. Arthritis Rheum. 1999; 42: 162.

9. Hamilton LC, Vojnovic I WT. A771726, the active metabolite of leflunomide, directly inhibits the activity of cyclo-oxygenase-2 in vitro and in vivo in a substrate-sensitive manner. Br J Pharmacol. 1999;127(7): 1589-1596.

10. Weithmann KU, Jeske S S V. Effect of leflunomide on constitutive and inducible pathways of cellular eicosanoid generation. Agents Actions. 1994; 41(3-4): 164-70.

11. B R. Clinical Experience With Leflunomide in Rheumatoid Arthritis. J Rheumatol. 1998; 53: 27-32.

12. Essalud. Guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de la artritis reumatoide. Minist Protección Soc. 2004; 1-50.

13. Popovic M, Stefanovic D, Pejnovic N, et al. Comparative study of the clinical efficacy of four DMARDs (leflunomide, methotrexate, cyclosporine, and levamisole) in patients with rheumatoid arthritis. Transpl Proc. 1998; 30(8):4135-6.

14. Singh JA, Furst DE, Bharat A, et al. Update of the 2008 American College of Rheumatology (ACR) Recommendations for the use of Disease-Modifying Anti- Rheumatic Drugs and Biologics in the treatment of Rheumatoid Arthritis (RA). Arthritis Care Res. 2012; 64(5): 625-39.

15. Smolen JS, Kalden JR, Scott DL, et al. Efficacy and safety of leflunomide compared with placebo and sulphasalazine in active rheumatoid arthritis: a double-blind, randomised, multicentre trial. Lancet. 1999; 23(353(9149)): 259-66.

16. Baede M. Arava (leflunomide) [product characteristics]. Fourth Assess Rep 2007 [Internet]. 1990; mixi: 941-54. Available from: publications_and_data_reports.shtml. Ùltima fecha de consulta 13 de marzo de 2016.

17. Sanofi-aventis Canada Inc. 2015, January. Arava (leflunomide) Antirheumatic, Immunomodulator Agent [product monograph]. Laval, Quebec CS-ACI. Sanofi 2015.

18. Sanofi-aventis U.S. LLC. 2011. Arava (leflunomide) [prescribing information]. Bridgewater(Massachusetts), NJ 08807. Sanofi-aventis U.S. LLC.

19. Rossert JA FE. Acute interstitial nephritis. In: Limited E, editor. Comprehensive Clinical Nephrology. Philadelphia:Elsevier; 2003. p. 769.

20. Ten RM, Torres VE, Milliner DS, et al. Acute interstitial nephritis: immunologic and clinical aspects. Mayo Clin Proc. 1988; 63(9): 921.

21. Michel DM KC. Acute interstitial nephritis. J Am Soc Nephrol. 1998; 9(3): 506-15.

22. J R. Drug-induced acute interstitial nephritis. Kidney Int. 2001; 60(2): 804-17.

23. Praga M GE. Acute interstitial nephritis. Kidney Int. 2010; 77(11): 956-61.

24. Evans SJ, Webb D, Lawson TM, et al. Renal tubular acidosis associated with leflunomide. Rheumatology [Internet]. 2007; 46(6): 1040. Available from: cgi/doi/10.1093/rheumatology/kem044. Última fecha de consulta 13 de marzo de 2016.

25. Hayda A, Hujair N, Kirkha B, et al. Chronic overdose of leflunomide inducing interstitial nephritis. Nephrol Dial Transpl. 2004; 19: 1334-5.
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