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December 1978

Tetracycline Nephropathy

Author Affiliations

Flushing, NY

Arch Intern Med. 1978;138(12):1866. doi:10.1001/archinte.1978.03630370072035

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To the Editor.—  In the May 1978 Archives (138:793-794), Orr et al report a case that they suggest documents doxycycline nephrotoxicity. We feel that the facts are much more suggestive of a prerenal deterioration of kidney function, due to the well-known gastrointestinal side effects of tetracyclines that are documented by Dr Orr and his co-workers in this article.Although there was a significant rise in the serum creatinine level, the graph on page 793 reveals a much more marked and disproportionate rise of the BUN value. The patient's physical examination revealed postural hypotension, tachycardia, and a decreased skin turgor. Her hematocrit reading was 47%, a distinctly high value for a patient with chronic azotemia, and therefore, confirmatory of a volume contracted state due to gastrointestinal losses and diuretic therapy.The above case is quite typical of the effects seen with tetracyclines in azotemic patients. Over and above their antianabolic effects,

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