Acute renal failure due to phenazopyridine (Pyridium) overdose: case report and review of the literature

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 transmitt...

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Bibliographic Details
Published in:	Pediatric nephrology (Berlin, West) West), 2006-11, Vol.21 (11), p.1760-1764
Main Authors:	Onder, Ali Mirza, Espinoza, Veronica, Berho, Mariana E, Chandar, Jayanthi, Zilleruelo, Gaston, Abitbol, Carolyn
Format:	Article
Language:	eng
Subjects:	Acetylcysteine - therapeutic use Acute Kidney Injury - chemically induced Acute Kidney Injury - drug therapy Acute renal failure Adolescent Care and treatment Carnitine - therapeutic use Case studies Complications and side effects Diagnosis Dosage and administration Drugs Female HIV Infections - complications HIV Infections - transmission Humans Infectious Disease Transmission, Vertical Methemoglobinemia - etiology Overdose Phenazopyridine - poisoning Pyridinium compounds Risk factors Sodium Bicarbonate - therapeutic use Suicide, Attempted Treatment Outcome
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Summary:	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.
ISSN:	0931-041X 1432-198X