Pregabalin-induced acute interstitial nephritis in a patient with normal renal function who required dialysis

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  • 血液浄化が必要となった, 正常腎機能患者のプレガバリンによる急性間質性腎炎が疑われた1例
  • 症例報告 血液浄化が必要となった,正常腎機能患者のプレガバリンによる急性間質性腎炎が疑われた1例
  • ショウレイ ホウコク ケツエキ ジョウカ ガ ヒツヨウ ト ナッタ,セイジョウジンキノウ カンジャ ノ プレガバリン ニ ヨル キュウセイ カンシツセイジンエン ガ ウタガワレタ 1レイ

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<p>The patient was an 84-year-old female with normal renal function. She was prescribed pregabalin 4 days before her admission. Nausea appeared the next day, and three days later she visited the emergency room because of respiratory discomfort. Her laboratory data showed a blood urea nitrogen (BUN) level of 87.4 mg/dL and a creatine (Cr) level of 9.34 mg/dL, and she was subsequently admitted to our hospital. Despite an intravenous injection of furosemide, her urine output did not increase, and hemodialysis was performed on day 2. Pregabalin-induced nephropathy was suspected, but the patient’s BUN and Cr values remained elevated until day 9, even though she had not taken pregabalin since day 1. Additional tests showed positivity for serum M-protein (IgG-κ) and urinary Bence Jones protein (IgG-κ). Paraproteinemic renal disease had to be ruled out. Therefore, bone marrow aspiration was performed on day 15, and a renal biopsy was conducted on day 16. Monoclonal gammopathy of undetermined significance was diagnosed based on the results of the bone marrow aspiration. The renal biopsy showed nearly intact glomeruli; the focal infiltration of lymphocytes and a small number of eosinophils in the interstitium; and no monoclonal deposits, crystals, or casts. Therefore, the patient was diagnosed with pregabalin-induced acute interstitial nephritis. Her Cr level decreased steadily from day 9 onwards, and hemodialysis was discontinued. On day 21, her Cr value fell to 1.07 mg/dL, and she was discharged from our hospital on day 23. One case of pregabalin-induced nephropathy has been reported previously, but the patient in that case had a history of chronic kidney disease. This is the first case of pregabalin-induced acute interstitial nephritis to involve a patient with normal renal function, and it was valuable to confirm the diagnosis via renal biopsy.</p>

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