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April 20, 1946


Author Affiliations

Resident in Surgery, Evanston Hospital; Associate Professor of Surgery, Northwestern University Medical School; Chief Surgeon, Evanston Hospital Evanston, Ill.

JAMA. 1946;130(16):1067-1069. doi:10.1001/jama.1946.02870160013005

It has been known for some time that irreparable damage may be done to the kidneys by the crystallization of sulfonamides in the urine. Gilligan and his associates1 and many others have shown the importance of adjuvant alkali therapy in the prevention of renal complications. Sulfonamides as well as acute infectious disease processes have an acidifying effect on the urine. Gilligan showed that 27 per cent of the total amount of sulfadiazine administered was crystallized in acid urine with a pH of 5 to 6. Solubility of the crystals was twenty to thirty times greater when the pH was 7.5 than when it was 5.0. Hence crystalluria can be reduced to a minimum if the urine is kept neutral or alkaline and if an adequate daily urinary excretion is maintained.2 Schwartz and his associates3 demonstrated that sulfadiazine produces less crystalluria than sulfathiazole (67.8 per cent

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