title: Acute renal failure due to phenazopyridine (Pyridium) overdose: case report and review of the literature.
abstract: Phenazopyridine (Pyridium) is a commonly used urinary tract analgesic. It has been associated with yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease. We report a 17-year-old female with vertically transmitted human immunodeficiency virus (HIV) infection, presenting with acute renal failure and methemoglobinemia following a suicidal attempt with a single 1,200 mg ingestion of Pyridium. She had no prior evidence of HIV nephropathy. The patient had a progressive nonoliguric renal failure on the 3rd day following the ingestion. She was treated with N-acetylcysteine, intravenous carnitine, and alkalinization of the urine. Her kidney biopsy revealed acute tubular necrosis with no glomerular changes. After 7 days of conservative management, she was discharged home with normal kidney function. To our knowledge, this is the second smallest amount of Pyridium overdose resulting in acute renal failure with no previous history of kidney disease.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960, Miami, FL 33156, USA. alim_md@hotmail.com
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: Veronica
authors.initials: V
authors.lastname: Espinoza
authors.forename: Mariana E
authors.initials: ME
authors.lastname: Berho
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy*; D000293:Adolescent; D002331:Carnitine / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008708:Methemoglobinemia / Q000209:etiology; D010621:Phenazopyridine / Q000506:poisoning*; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D017693:Sodium Bicarbonate; D010621:Phenazopyridine; D002331:Carnitine; D000111:Acetylcysteine