Abstract: PUB005
Topiramate (TPM)-Induced Fanconi Syndrome (FS) and AKI
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Jiatu, Angela, James J Peters VA Medical Center, New York, New York, United States
- Rohatgi, Ria, Harborfields Central School District, Greenlawn, New York, United States
- Rohatgi, Rajeev, James J Peters VA Medical Center, New York, New York, United States
- Berlinkova, Daniela, James J Peters VA Medical Center, New York, New York, United States
Introduction
TPM is an antiepileptic, but its use has expanded beyond FDA indictions, leading to frequent administration. TPM causes renal side effects, like metabolic acidosis, but we report a second case of FS and AKI.
Case Description
A 41-year-old male with a medical history of hypertension, migraines, and tonic-clonic seizures presented to the emergency department with hyponatremia and AKI. His chemistry showed severe hypo-osmolal hyponatremia (serum sodium (SNa) 116 mEq/L) and AKI (serum creatinine (Scr) 3.0 mg/dL).The urine Na was 25 mEq/L and osmolality 136 mOsm/kg. Home medications included hydrochlorothiazide (HCTZ) and lisinopril (LIS), and, thus, we surmised the hyponatremia was caused by HCTZ. He had been started on 100 mg TPM 13 months prior to AKI. Urinalysis (UA) showed persistent 3+ glucosuria and pH of 7.0, with normal serum glucose. HCTZ and LIS were discontinued with resolution of hyponatremia while TPM, ceased 4 days later, led to improvement in SCr (Fig. 1) and UA (Table 1).
Discussion
In short, the hyponatremia is likely due HCTZ while FS and AKI was caused by TPM. This case represents the second case of FS and AKI reported. FS/AKI is a rare complication and needs to be further studied to identify the risk factors.
Acknowledgment
This work was supported by Merit Review I01 BX003015 (RR).
Table 1. The change in UA before, during and after stopping TPM
| 113 months prior to TPM | At admission on TPM | Day 4 hospitalization, on TPM | Day 5 after stopping TPM | 2 months after stopping TPM | |||
| Urine Glucose | Neg | 3+ | 3+ | Neg | Neg | ||
| Urine pH | 6 | 7 | 7 | 6.5 | 5.5 | ||
| Urine Protein | Neg | Trace | Trace | Neg | Neg | ||
Fig 1. Changes in SCr in relation to TPM administration- before and after hospitalization.