Pre-existing Renal Impairment Research Articles

Severe Hypersensitivity Reactions to Allopurinol

The frequency of severe reactions to allopurinol has probably been underestimated. A retrospective study encompassing a five-year period has yielded 20 patients with severe hypersensitivity reactions to allopurinol. Patients with preexisting renal impairment or who were receiving concomitant thiazide diuretics appeared to be especially predisposed. Cutaneous reaction patterns included maculopapular eruptions, exfoliative dermatitis, and toxic epidermal necrolysis. eosinophilia was uncommon. Forty percent of the patients developed hepatic involvement and 45% had renal involvement. Hepatic and renal changes usually were reversible and were not unique to any one cutaneous reaction pattern. Three patients with renal involvement required prolonged administration of systemic steroids. Complications included sepsis, decubitus ulcers, and thromboembolism. Two patients required hyperalimentation. Sequelae included dry eyes, pigmentary disturbances, and keloids. Three patients died as a result of their reaction. It is concluded that allopurinol should be used only in select patients, and the dosage should be modified if renal disease exists.

Reversible Nephrotoxicity Associated With Cephalothin Therapy

A 53-year-old man with scalp cellulitis developed acute renal failure after sodium cephalothin therapy. The patient probably had preexisting renal disease. Discontinuance of cephalothin was followed by improvement of the renal function. Specimens from a renal biopsy performed during the recovery phase showed nonspecific changes in the renal tubular epithelium, similar to those seen in animals treated with large doses of cephalothin. Previously reported cases of cephalothin nephrotoxicity, along with this case, caution the clinician to proceed with care in the treatment of azotemic patients with cephalothin.