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Voriconazole-associated salt-losing nephropathy.

Abstract
A 74-year-old man was diagnosed with nephrotic syndrome due to focal segmental glomerulosclerosis, and steroid therapy was initiated. Subsequently, he was affected by deep mycosis, and hence, voriconazole (VRCZ) was administered. On the 16th day, he was transferred to our hospital because of somnolence and malaise. His systolic blood pressure was approximately 80 mmHg, and he showed decreased skin turgor, indicating volume depletion. Laboratory analysis revealed hyponatremia and liver dysfunction. Discontinuation of VRCZ and drip infusion of normal saline improved the consciousness disorder, hyponatremia, and liver dysfunction. The levels of antidiuretic hormone (ADH) and plasma renin activity were elevated. This patient showed high excreted urine sodium, despite volume depletion and low serum osmolality. Therefore, this patient was diagnosed with salt-losing nephropathy (SLN). SLN should be considered for treatment of VRCZ-associated hyponatremia, together with syndrome of inappropriate secretion of ADH.
AuthorsJunya Teranishi, Katsuyuki Nagatoya, Tomoko Kakita, Yoko Yamauchi, Hirohisa Matsuda, Tatsuhiko Mori, Toru Inoue
JournalClinical and experimental nephrology (Clin Exp Nephrol) Vol. 14 Issue 4 Pg. 377-80 (Aug 2010) ISSN: 1437-7799 [Electronic] Japan
PMID20567873 (Publication Type: Case Reports, Journal Article)
Chemical References
  • AVP protein, human
  • Antifungal Agents
  • Biomarkers
  • Neurophysins
  • Protein Precursors
  • Pyrimidines
  • Triazoles
  • Vasopressins
  • Sodium Chloride
  • Sodium
  • Renin
  • Voriconazole
Topics
  • Aged
  • Antifungal Agents (adverse effects)
  • Biomarkers (blood)
  • Chemical and Drug Induced Liver Injury (etiology, physiopathology)
  • Fluid Therapy
  • Humans
  • Hyponatremia (blood, chemically induced, physiopathology, therapy)
  • Kidney Diseases (blood, chemically induced, physiopathology, therapy)
  • Liver (drug effects, physiopathology)
  • Male
  • Neurophysins (blood)
  • Protein Precursors (blood)
  • Pyrimidines (adverse effects)
  • Renin (blood)
  • Sodium (blood)
  • Sodium Chloride (administration & dosage)
  • Time Factors
  • Treatment Outcome
  • Triazoles (adverse effects)
  • Vasopressins (blood)
  • Voriconazole
  • Water-Electrolyte Balance (drug effects)

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