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"apellidos" => "Núñez Orantos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracaso renal atípico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 900 "Tamanyo" => 39294 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 67-year-old man was hospitalized for a study of constitutional syndrome with significant asthenia, loss of 15<span class="elsevierStyleHsp" style=""></span>kg of weight and cessation of self-care. The patient was diagnosed with human immunodeficiency virus infection C3 and cerebral toxoplasmosis and was started on treatment with sulfadiazine (1.5<span class="elsevierStyleHsp" style=""></span>g/6<span class="elsevierStyleHsp" style=""></span>h orally), pyrimethamine (75<span class="elsevierStyleHsp" style=""></span>mg/day orally) and folinic acid (15<span class="elsevierStyleHsp" style=""></span>mg/day orally). At 5 days, the patient's general condition deteriorated, presenting spatial and temporal disorientation and oligoanuria, with a diuresis rate of 10<span class="elsevierStyleHsp" style=""></span>mL/h and a creatinine level of 3.7<span class="elsevierStyleHsp" style=""></span>mg/dL. After observing the urine sediment under microscope (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), we reached the diagnosis of the patient's type of renal failure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In tubular necrosis by sulfadiazine crystals, the urine sediment study plays an essential role by observing crystals of the N-acetyl-sulfadiazine metabolite forming structures characteristically described as “fan-shaped” or in “sheaves of wheat”. The presence of crystalluria <span class="elsevierStyleItalic">per se</span> is not diagnostic of the condition but should lead to strict renal function monitoring. In terms of treatment, the most effective measures have been blood volume expansion and urine alkalinization.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Sulfadiazine-induced renal toxicity has been well known since the 1940s. The emergence of more water-soluble sulfonamides and new antibiotics means that general physicians are less accustomed to its toxicity. In the era of technological sophistication, a diagnostic test as elemental as urine sedimentation can be the key to directing the diagnosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-28" "fechaAceptado" => "2018-10-07" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tornero Romero F, Cabello Clotet N, Núñez Orantos MJ. Fracaso renal atípico. Rev Clin Esp. 2019;219:279.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 900 "Tamanyo" => 39294 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000005/v1_201905300945/S2254887419300669/v1_201905300945/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000005/v1_201905300945/S2254887419300669/v1_201905300945/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419300669?idApp=WRCEE" ]
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