Archivos suplementarios
Palabras clave
Nefritis túbulo intersticial
leflunomida.
leflunomida.
Cómo citar
1.
Hurtado M, Barbosa Silva OR, Santacruz F. Nefritis túbulo intersticial por leflunomida. Rev. Colomb. Nefrol. [Internet]. 18 de noviembre de 2016 [citado 3 de julio de 2024];3(2):132-6. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/229
Resumen
La asociación entre compromiso renal como nefritis túbulo intersticial y el uso de leflunomide no está descrito en la literatura, pues en la medida en que este medicamento no es reconocido como nefrotóxico, no se realiza seguimiento de la función renal bajo su uso. Presentamos el caso de una paciente que ingresó al Hospital Universitario Clínica San Rafael por síntomas clínicos inespecíficos y deterioro rápido de la función renal. Tras descartar las principales causas fue llevada a biopsia renal, y se comprobó la presencia de nefritis túbulo intersticial severa. En ese momento el único agente exposicional era leflunomida. Con posterioridad a la suspensión del medicamento se evidenció la recuperación completa de la función renal. Es nuestra intención exponer este caso con el fin de llamar la atención sobre la relación entre el uso de leflunomida y nefrotoxicidad, y de tal forma promover la documentación de casos similares.
Citas
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: http://www.ipcc.ch/publications_and_data 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: http://www.rheumatology.oxfordjournals.org 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.
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: http://www.ipcc.ch/publications_and_data 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: http://www.rheumatology.oxfordjournals.org 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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