Renal Failure and Interstitial Nephritis Due to Penicillin and Methicillin

Nephropathy due to penicillin or methicillin was observed in seven patients. Maximum dosage ranged from 20 to 24 gm per day for methicillin and from 20,000,000 to 60,000,000 units for penicillin. Fever appeared in a minimum of eight days, associated with marked eosinophilia and rash (in four patients). Urinary abnormalities and azotemia (blood urea nitrogen of 50 to 130 mg per 100 ml) occurred in all. All but one recovered. Renal tissue, examined in four patients, showed tubular damage and interstitial accumulation of mononuclear cells and eosinophils without glomerular abnormalities or arteritis. In the only patient investigated immunologically an unusually intense immune response to penicillin was found. Immunofluorescent studies showed penicilloyl hapten firmly bound to his kidney tissue and the presence there of gamma globulin. The clinical features of an allergic reaction together with the immunologic findings support, but do not prove, a hypersensitivity mechanism for this nephropathy.