Nephropathy caused by methicillin therapy for staphylococcal septicemia.

Nephropathy, eosinophilia and fever were observed in an 18-year-old man being treated for staphylococcal septicemia. Parenteral challenge with suspected sensitizing agents confirmed methicillin as the likely offender. Review of the literature relating to methicillin-induced nephropathy suggests a hypersensitivity origin for this disorder, but immunologic and ultrastructural investigation to date has failed to elucidate pathogenesis.

Immunologically mediated drug-induced acute renal failure.

(1) AIN is the most frequent pattern of drug-induced immunologically mediated renal injury. A number of drugs may be responsible for AIN, namely methicillin and other penicillin derivatives, rifampicin, phenindione and sulfonamides. Particular clinical and pathological features often suggest an immune pathogenetic mechanism. IgG anti-TBM and IgE antibodies have been found in only a few cases and it is likely that antibody-mediated and cell-mediated injury may operate in the same patient. (2) Only few examples of drug-induced vasculitis and glomerulonephritis are known, and the pathophysiology of this kind of renal damage is poorly understood.