A severely burned patient developed heavy proteinuria, hematuria, eosinophilia, and azotemia after receiving topical therapy with sulfadiazine silver. A renal biopsy specimen revealed interstitial nephritis and intramembranous electron-dense deposits in the glomerular basement membrane, suggesting an immune-complex mechanism of renal injury. Improved renal function and remission of proteinuria occurred after five months of therapy with immunosuppressive agents. Although renal injury following sulfonamide administration orally is well-known, there are, to our knowledge, no reports of the nephrotic syndrome in association with topical therapy with sulfonamides.
Owens CJ, Yarbrough DR, Brackett NC. Nephrotic Syndrome Following Topically Applied Sulfadiazine Silver Therapy. Arch Intern Med. 1974;134(2):332-335. doi:10.1001/archinte.1974.00320200142021