Acute Renal Failure Caused by Hypersensitivity to Polymyxin B Sulfate

Abstract

A patient had reversible acute renal failure associated with polymyxin B sulfate therapy. Unusual cells in the urinary sediment, renal glycosuria, and eosinophilia during the oliguric stage were interesting clinical features. A renal biopsy performed early in the course of acute renal failure revealed severe tubular damage as well as an acute diffuse interstitial nephritis. The clinical and histological findings suggested that there were two pathogenetic mechanisms producing the symptoms. One was the specific toxic effects of polymyxin B on the renal tubular cells.The other was a hypersensitivity reaction to polymyxin B manifested by a diffuse interstitial nephritis. THE NEPHROTOXIC potential of the polymyxins is well known, but acute renal failure caused by these antibiotics has been infrequently reported.' The pathogenesis of acute renal failure in these cases has not been clear. This communication re¬ ports the clinical and pathological features of a case of acute renal failure precipitated by a hypersen¬ sitivity reaction to polymyxin B sulfate.A 44-year-old white man was admitted on Sept 28, 1966, because of fever and a productive cough of ten days' dura¬ tion.Six years previously, the patient had experienced an acute pneumonia which responded initially to antibiotic therapy. Shortly afterward, however, he began to complain of cough and severe dyspnea. A persistent density was dis¬ covered in the right lower lung field on roentgenograms. The lower lobe of the right lung was excised in July 1961. Pathological examination of the resected specimen revealed chronic inflammation of the lung parenchyma and adjacent pleura. The patient remained well following surgery until three years prior to admission. He then began to have fre¬ quent pulmonary infections, associated with a chronic cough and increasing dyspnea on exertion. The cough was oc¬ casionally productive of blood-streaked sputum. The onset of the patient's present illness was similar to that of his previous pulmonary infections, but symptoms progressed more rapidly. He had received several antibiotics prior to admission, but fever had persisted. Sputum specimens cul¬ tured during this time grew Pseudomonas aeruginosa. Therefore, kanamycin sulfate was prescribed a few days before the patient's transfer to the Veterans Administra¬ tion Hospital, Madison, Wis.Physical examination on admission revealed an acutely ill man with fever and chills. The rectal temperature was 104 F (40 C). He was weak, pale, and thin. His weight was 62.3 kg ( 137 lb). The blood pressure was 120/70 mm Hg and pulse was rapid, weak, and regular. Examination of the chest revealed decreased expansion of the right hemithorax with dullness and bronchial breathing over the right upper lung field. Results of the remainder of the examination were unremarkable. Laboratory studies disclosed the fol¬ lowing values: hematocrit, 37%; white blood cell count (WBC), 14,000/cu mm, with 87% polymorphonuclear neutrophils, 7% banded neutrophils, 4% lymphocytes, 2% basophils, and no eosinophils; blood ur...

Colistin and Acute Renal Failure: A Centre’s Experience

“…A study on the nephrotoxicity of colistin reported patients clinically diagnosed with drug-related acute tubular necrosis, with histological confirmation in three of them (33). Beirne et al also reported acute interstitial nephritis due to hypersensitivity to this antibiotic (31).…”