ACUTE RENAL FAILURE ASSOCIATED WITH SULFUR CALCULI

Abstract

An 85-year-old Japanese man presented with abdominal discomfort and general fatigue. History included (stage A1) prostate cancer, G1T1a transitional cell carcinoma of the bladder for 4 years and ulcerative colitis, which had been treated with 4.5 gm. sulfasalazine daily for 14 years. Laboratory examination showed renal failure (serum blood urea nitrogen was 26 mg./dl. and creatinine was 1.71 mg./dl.). Ultrasonography, computerized tomography and x-ray revealed bilateral hydronephrosis, right multiple renal stones, a ureteropelvic junction stone and a left ureterovesical junction stone (see figure). The left ureteral stone was spontaneously discharged 5 days after the initial consult. The patient underwent 4 sessions of shock wave lithotripsy and percutaneous nephrolithotomy to remove stones in the right renal pelvis and ureteropelvic junction, after ureteral stenting. After stenting, renal function returned to normal (blood urea nitrogen 10 mg./dl. and serum creatinine 0.89 mg./dl.). Stone analysis revealed acetylsulfapyridine, which is a metabolite of sulfasalazine. After the final diagnosis, sulfasalazine was replaced with mesalamine (5-aminosalicylic acid) to treat the ulcerative colitis, and at 6-month followup no recurrence of stone disease was observed.