Bismuth Nephrotoxicity: Report of a Case
A case of renal poisoning by bismuth thioglycolate is reported which demonstrates the nephrotoxicity of bismuth compounds in the pediatric age group. For treatment of warts the patient received a relatively small amount of bismuth thioglycollate (1.3 mg/kg body wt), and although the symptomatology was mild, the degree of azotemia was severe. Evidence of both tubular and glomerular damage was present, the former reflected by fixed urinary specific gravity and minimal glycosuria in the presence of a normal blood sugar, and the latter by azotemia and mild proteinuria. Backward diffusion of creatinine through damaged tubular epithelium probably contributed to the observed elevated plasma creatinine value, and the presence of a high anion content of serum probably represented retained phosphate, sulfate, and organic acids. The observed maculopapular rash probably corresponded to the socalled erythema of the ninth day, described previously as a rare manifestation of bismuth toxicity. The therapy employed was that for acute renal failure, but chelating agents, which are potential nephrotoxins, were not employed because of the known rapid excretion of bismuth thioglycollate. Rehydration was carried out, and electrolyte and protein intake was limited until diuresis was well established and the blood urea nitrogen had begun to fall. To avoid hyperkalemia, potassium restriction was carried out. Normal renal function was restored within a month after the onset of renal injury. It is suggested that the degree of sensitivity to the metal was related to the age of the patient and to the structural maturity of the kidney, for all cases of bismuth nephropathy reported the past 15 yr have occurred in the pediatric age group, children less than 3 yr being the most severely affected.
- Research Organization:
- Yale Univ., New Haven
- Sponsoring Organization:
- USDOE
- NSA Number:
- NSA-17-038720
- OSTI ID:
- 4645555
- Journal Information:
- New England Journal of Medicine, Journal Name: New England Journal of Medicine Journal Issue: 26 Vol. 265; ISSN 0028-4793
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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Related Subjects
AGE
ANIONS
BISMUTH COMPLEXES
BLOOD
BLOOD PLASMA
CREATININE
DENSITY
DIFFUSION
DISEASES
DRUGS
ELECTROLYTES
GLUCOSE
GLYCOLIC ACID
KIDNEYS
MAN
MEDICINE
METABOLISM
ORGANIC ACIDS
ORGANIC NITROGEN COMPOUNDS
ORGANIC SULFUR COMPOUNDS
PHOSPHATES
PHYSIOLOGY
POTASSIUM
PROTEINS
QUANTITY RATIO
RECOVERY
SENSITIVITY
SKIN
SUGARS
SULFATES
TOXICITY
UREA
URINE
VIRUSES
WARTS
WATER