Aminoglycoside nephrotoxicity following single-dose cystoscopy prophylaxis.

OBJECTIVE: To report a case of gentamicin-associated acute tubular necrosis following single-dose exposure. SETTING: Central-city, university-affiliated teaching hospital. PATIENT: An 82-year-old man, admitted for evaluation of shortness of breath, appetite reduction with weight loss, and stable renal insufficiency, developed urinary retention, which prompted a urologic evaluation followed by a cystoscopy. INTERVENTIONS: A single 1.6-mg/kg (actual body weight) dose of gentamicin was administered as prophylaxis prior to this procedure. RESULTS: A significant decline in renal function was observed 48 hours following gentamicin administration. A nephrology evaluation excluded pre- and postrenal causes and attributed this episode of nonoliguric acute tubular necrosis to a single dose of gentamicin. CONCLUSIONS: Although not consistent with currently proposed mechanisms and reported onset of aminoglycoside-induced nephrotoxicity, an etiology other than that concluded by this case report appears unlikely.

Pulse methylprednisolone therapy in idiopathic, rapidly progressive glomerulonephritis.

Idiopathic crescentic glomerulonephritis is associated with a 70% to 80% incidence of end-stage renal failure. Oral corticosteroid therapy in combination with immunosuppressive agents or anticoagulants has not altered the prognosis of this disease. We have seen five adults with idiopathic crescentic glomerulonephritis and treated them with intravenous methylprednisolone. Before therapy, the average serum creatinine concentration was 7.4 +/- 1.3 mg/dL (chi-square +/- SEM). This value declined to 2.0 +/- 0.48 mg/dL within 4 weeks. All patients continue to maintain stable renal function over an average follow-up period of 19 months (range 1.5 to 36 months). These data suggest that a prospective controlled trial of this therapy is warranted in the management of this entity.

Acute renal failure in legionnaires' disease: report of a case.

The renal insufficiency which has been described in some of Legionnaires' Disease, has not been characterized. We describe a patient who developed severe oligoanuric renal failure associated with Legionnaires' Disease. Renal biopsy revealed acute tubular necrosis.

Effect of albumin infusion on renal glucose reabsorption in the rat.

Clearance and micropuncture techniques were employed to assess the relationship between renal glucose and sodium reabsorption in the rat. Late proximal tubular fluid was collected from surface nephrons before and at two intervals after the infusion of hyperoncotic albumin by a double recollection technique. Plasma glucose levels were maintained at 28-44 mM throughout. Proximal tubular reabsorptive rates for both glucose and sodium were elevated 20 min after the start of the hyperoncotic infusion. Continued infusion of the hyperoncotic albumin resulted in a natriuresis and a parallel fall in proximal glucose and sodium reabsorption. Changes in maximal glucose reabsorption rates for the whole kidney paralleled changes in glucose reabsorption in surface nephrons. The addition of calcium and magnesium to the hyperoncotic infusate diminished the natriuresis but did not alter the relationship between sodium and glucose reabsorption. These observations indicate a close relationship between proximal tubular glucose reabsorption and sodium reabsorption during hyperoncotic infusion.

Glomerulotubular relationships in glomerulonephritis.

Clearance techniques were employed to examine glomerulotubular relationships in a model of chronic glomerulonephritis in the rat. Clearance ratios were found to be equal in both kidneys in the same animals, indicating that the nephron population was functioning in a homogeneous manner. Glucose titration curves were normal and this finding also indicates that glomerulotubular relationships were intact for the composite nephron population. In contrast to models of chronic renal disease with nonglomerular lesions, nephron filtration rate was reduced in these animals. However, the animals still exhibited a capacity to respond to contralateral nephrectomy by increasing filtration rate in the residual nephrons.