CEFUROXIME-INDUCED ACUTE-RENAL-FAILURE

Although drug-induced allergic nephritis (DIAN) is one of the most com mon problems seen by nephrologists, its true frequency is probably und erestimated. Diagnosis is often difficult and is typically only made i n patients without another explanation for deteriorating renal functio n, and is often based solely on improvement after drug withdrawal. The diagnosis may be made more difficult due to lack of typical allergic symptoms, presence of other drugs, or confounding factors and equivoca l noninvasive laboratory studies. The gold standard for diagnosis is r enal biopsy, but it is only rarely performed during the acute phase of the reaction and is not without risk. It is important to keep a high index of suspicion with regard to DIAN since it is usually rapidly rev ersible. Failure to recognize it and discontinue the offending agents may result in unnecessary morbidity and occasionally, irreversible ren al failure. In our patient, DIAN possibly was related to cefuroxime, b ut the patient did not experience associated allergic symptoms. The di agnosis was supported by the temporal course of renal deterioration du ring exposure to cefuroxime and improvement on its discontinuation; th e pattern repeated with rechallenge. This is the first reported case o f suspected DIAN due to cefuroxime.