Tubulointerstitial nephritis induced by the leukotriene receptor antagonist pranlukast.
A 7-year-old boy with asthma was receiving the leukotriene receptor antagonist pranlukast (Ultair; SmithKline Beecham; Pittsburgh) as part of an open-label clinical trial. The patient's asthma improved, and he remained asymptomatic; but routine study evaluations 9 to 12 months into therapy showed microhematuria, proteinuria, glucosuria, anemia, and renal insufficiency. Renal biopsy demonstrated changes classic for acute allergic tubulointerstitial nephritis (ATIN), with mixed interstitial inflammatory infiltrate including eosinophils. Within 6 months of pranlukast withdrawal, anemia resolved and urinary sediment and renal function normalized. The case demonstrates that hypersensitivity reaction to pranlukast and resultant ATIN is possible, and that periodic urine testing in patients receiving pranlukast should be considered.
Schurman
S J
SJ
Department of Pediatrics, University of South Florida and All Children's Hospital, St. Petersburg 33701, USA. schurman@allkids.org
Alderman
J M
JM
Massanari
M
M
Lacson
A G
AG
Perlman
S A
SA
D000208:Acute Disease; D001249:Asthma / Q000188:drug therapy; D001706:Biopsy; D002648:Child; D002867:Chromones / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D006029:Glycosuria / Q000209:etiology / Q000652:urine; D006417:Hematuria / Q000209:etiology / Q000652:urine; D006801:Humans; D020024:Leukotriene Antagonists / Q000009:adverse effects*; D008297:Male; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D011507:Proteinuria / Q000209:etiology / Q000652:urine
D002867:Chromones; D020024:Leukotriene Antagonists; D003404:Creatinine; C047681:pranlukast