Tetracycline-induced acute interstitial nephritis as a cause of acute renal failure

Acute interstitial nephritis with severe acute renal failure is reported fo llowing tetracycline treatment in a 22-year-old male medical student. Acute renal failure developed within 48 h of a single repeated tetracycline dose and presented 2 days after taking the drug when there was oliguria, nausea , vomiting and bilateral loin pain without rash and fever. The serum creati nine concentration was 8.6 mg/dl and blood urea nitrogen 84 mg/dl. Examinat ion of the urinary sediment revealed 15-20 RBCs per high-power field, and o ccasional granular and hyaline casts. Percutaneous renal biopsy performed i mmediately after admission revealed acute interstitial nephritis with immun e complexes along the tubular basement membrane and intact glomeruli and wa s consistent with type 2 interstitial nephritis. Within 4 days of commencem ent of steroid treatment and hemodialysis, the urine output started to incr ease with improvement in serum creatinine and BUN levels and after 2 weeks of therapy hemodialysis was discontinued. He remains well 1 year following his illness with complete normalization of his renal function. Although a n umber of renal side effects of tetracycline antibiotics have been reported, acute interstitial nephritis is rarely caused by tetracycline treatment ha ving been reported just twice following systemic use of minocycline.