Quinine may damage the kidneys by a number of mechanisms. It is important to recognize the cause and to distinguish it from comorbid conditions.
Quinine in the plasma is bound to alpha-1 acid glycoprotein.
Renal injury may take the form of:
(1) interstitial nephritis
(2) hemolytic-uremic syndrome
(3) disseminated intravascular coagulopathy
(4) cortical necrosis
Features:
(1) The onset of a renal disease after starting quinine (sometimes with just a single dose).
(2) Exclusion of other causes for the renal injury.
(3) Improvement after the quinine is discontinued.
(4) The patient may have other forms of quinine toxicity (immune thrombocytopenia, granulomatous hepatitis, hypersensitivity reaction, etc).
(5) Recurrence of renal disease if the patient is exposed again to quinine (something usually not done intentionally).
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Specialty: Nephrology, Pharmacology, clinical
