A patient treated for refractory migraine with methysergide for several months presents with flank pain and progressive renal impairment. Imaging shows bilateral hydronephrosis. The complication to suspect is:

• A Ergot-induced bilateral renal artery stenosis
• B Analgesic nephropathy with papillary necrosis
• C Retroperitoneal fibrosis encasing the ureters ✓
• D Obstructive uropathy from oxalate calculi

Explanation

Methysergide, a 5-HT2 antagonist derived from lysergic acid, was used for migraine prophylaxis until recognition that prolonged continuous therapy causes inflammatory retroperitoneal, pleural, and cardiac valvular fibrosis. Fibrotic tissue encases the ureters, producing obstructive hydronephrosis and reversible renal impairment if the drug is stopped. Analgesic nephropathy is a parenchymal process from chronic phenacetin-like NSAID use, and ergotamine causes vascular spasm rather than fibrosis.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.