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Kidney Week

Abstract: PO0111

Furosemide: An Unusual Cause of Acute Interstitial Nephritis Requiring Hemodialysis: First Case Report

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Alhalabi, Hassan, Dallas Nephrology Associates, Irving, Texas, United States
Introduction

Furosemide, a loop diuretic, is widely used for volume control and is a known cause of acute interstitial nephritis. However, AIN due to furosemide is not typically associated with abrupt and severe acute kidney injury (AKI). Here we report a patient who developed severe AKI requiring hemodialysis shortly after receiving furosemide.

Case Description

A 65 year old male with a history of hypertension was started on oral furosemide 20 mg daily for edema in his legs. One week later he presented to the emergency room complaining of oliguria and worsening edema. Laboratory findings were significant for a serum creatinine of 37.8 mg/dL and potassium 7.8 mmol/L. Patient required emergent hemodialysis for volume control, clearance and hyperkalemia, and continued to require HD every other day. Serologic work-up included a normal C3, C4, ANA, ANCA, anti-GBM, and SPEP/UPEP. Urinalysis showed small blood, no protein, 12-15 RBC’s, 10 WBC’s. Renal ultrasound was normal. A kidney biopsy was performed which demonstrated interstitial edema with patchy inflammatory cell infiltrates with eosinophils. The tubules were dilated and showed significant degenerative changes in tubular epithelial cells. The patient was started on treatment for acute interstitial nephritis with oral prednisone 60 mg daily with a subsequent slow taper. Kidneys did not recover and he was placed on hemodialysis three times a week with close monitoring of kidney functions.

Discussion

Furosemide, a loop diuretic, is widely used for volume control. To our knowledge, this is the first report of AIN associated with loop diuretics that resulted in severe AKI requiring hemodialysis. Unfortunately, our patient did not respond to high dose steroids and he continued to require hemodialysis three times a week. Our report highlights the importance of close monitoring of any potential toxicities that may be associated with such medications.