Mustafa AÇIKALIN, Garip ŞAHİN, İlter BOZACI

Ekstaziye Bağlı Toksik Hepatit ve Minimal Değişiklik Hastalığı

Minimal değişiklik hastalığı(MDH), NIL hastalığı, çocuklarda nefrotik sendromun en sık nedeni iken erişkinlerde de nefrotik sendromun en önemli nedenlerindendir. Elektron mikroskopta ayaksı çıkıntılarda yaygın yapışıklık olması; immünfloresan mikroskopta depolanma olmaması; glomerüllerin seçici geçirgenliğinde şiddetli fonksiyon kaybı karakteristik bulgularıdır. MDH, sıklıkla idiopatiktir. MDH ile ilişkili sekonder nedenler ise ilaçlar, tümörler, allerji, enfeksiyonlar ve diğer glomerüler hastalıklardır. Ekstazi (3,4 metilendioksi -N-metilamfetamin, MDMA) C11H15NO2 formülüne sahip psikoaktif bir maddedir. Kullanımına bağlı ortaya çıkan etkiler arasında malign hipertansiyon, taşikardi, hipertermi, akut böbrek yetmezliği, hiponatremi, rabdomyoliz, ajitasyon, anksiyete, hepatotoksisite yer almaktadır. Olgumuzda, MDH’nın atipik klinik bulgularının olabileceğini ve benzer bulgularla gelen olgularda sekonder nedenler arasında ekstazi kullanımının da akılda tutulması gerektiğini vurgulamayı amaçladık.

Minimal Change Disease and Toxic Hepatitis Due to Ecstasy

Minimal change disease (NIL (Nothing In Light microscope) disease) is the most common cause of nephrotic syndrome in childhood; and one of the most common causes of nephrotic syndrome in adults. Characteristic findings are: diffuse foot process effacement in electrone microscopy, no complement or immunoglobulin deposits on immunofluorescence microscopy , severe functional defect in glomerular permselectivity. Most cases of MCD are idiopathic or primary. Secondary MCD is associated with the following: drugs, tumors, allergy, infections and other glomerular diseases. Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is a synthetic psychoactive compound with C11H15NO2 formula. Malign hypertension, tachycardia, hyperthermia, acute kidney failure, hyponatremia, rhabdomyolisis, neurologic symptoms like agitation, anxiety, hepatotoxicity can be seen due to ecstasy abuse. In our case, we wanted to mention that MCD cases can come with atypical clinical findings and we should keep ecstasy abuse in mind as secondary reason at these types of cases.

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