Uses of sulfadiazine:
(1) toxoplasmosis, especially in HIV-positive patients
(2) Pneumocystis carinii (jirovecii)
(3) topical therapy in burns
(4) urinary tract infection
(5) Shigella dysentery
(6) prophylaxis for meningococcemia
Risk factors for nephropathy:
(1) dehydration or poor fluid intake
(2) acidic urine
(3) prolonged use at high doses
(4) pre-existing renal disease
Clinical findings:
(1) flank or lumbar pain
(2) oliguria or anuria with acute renal failure
(3) gross or microscopic hematuria
(4) proteinuria
(5) urine crystals in the form of "sheaves of wheat"
(6) occasionally nephrolithiasis
Management:
(1) use the lowest possible effective dose
(2) promote diuresis with fluid intake > 2 liters per day
(3) alkalinize the urine to a pH > 7.15, often with sodium bicarbonate
(4) in severe cases consider direct pelvic irrigation with sodium bicarbonate or hemodialysis
