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When seen, some habits of calcium oxalate monohydrate crystals (whewellite) are so typical of ethylene glycol intoxication that they may be helpful for its diagnosis when circumstances are not clearly established., (Copyright © 2014 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Purpose: Management of acetaminophen overdose focuses on the risk hepatic failure. However, acute renal failure, although less frequent, can lead to serious metabolic complications and require hemodialysis. We report three cases of acute renal failure related to acetaminophen overdose., Clinical Features: Three patients, aged 17-46 yr ingested acetaminophen 19 to 32 g, and were admitted to the intensive care unit because of acute liver failure without hepatic coma. While liver function improved, each patient developed acute renal failure starting on the fourth day. Four sessions of hemodialysis were required in one patient because of anuria. Hepatic function improved from the fourth to the ninth day in each case, whereas renal function recovered later, 10-20 days after ingestion. Investigations were negative for other causes of renal failure, and acute tubular necrosis due to acetaminophen was suspected., Conclusion: The pathophysiology of this type of acute tubular necrosis remains unclear and thus, there is no specific treatment. Nevertheless, in all cases of acetaminophen overdose, we suggest following serum creatinine levels during the first week, regardless of the degree hepatic failure or quantity of acetaminophen ingested.

Infusion of 10% Dextran 40,000 (Dextran 40) solute was reported to induce acute renal failure with oligoanuria in some patients and in animals during experimental pharmacological studies. Dogs were infused daily with 40 ml.kg-1 a large volume (twice the dose intended in human clinical practice) of a 3,5% dextran 40 solute, associated with electrolytes Plasmacair After 30 days of administration, no differences in creatinine clearance and renal structures were noted between control and treated animals.

Angiotensin converting-enzyme inhibitors cross the placenta and modify the maternal, foetal and utero-placental renin-angiotensin system. Eight cases of pregnancy in women taking captopril have been published, 7 other cases being reported in this review paper. There were one spontaneous and 2 therapeutic abortions, one of which disclosed a malformation of uncertain diagnosis and imputation. One intrauterine death at 28 weeks was probably due to the severity of the maternal disease. Two children born to mothers also treated with frusemide died of neonatal anuria. Delivery or caesarean section occurred before term in 8 cases, and there were 3 cases of neonatal respiratory distress with a favourable outcome. Finally, one mother gave birth at term to twins of normal weight. The cases with respiratory distress can be attributed to the mother's hypertension, to prematurity and/or to concomitant treatment with beta-blockers, while the cases with anuria seem to be due to inhibition of the effects of angiotensin on renal haemodynamics, with salt depression as a possible aggravating factor. Treatment with angiotensin converting enzyme inhibitors does not seem to warrant therapeutic abortion. However, these drugs are contra-indicated in pregnancy and should only be given to women wishing to become pregnant if they present with resistant and dangerous arterial hypertension. A programme of pharmacovigilance is being set up to follow up such pregnancies.

The effects of renal arteriography (n = 94) and intraveinous urography (n = 137) on renal function were studied in 80 renal transplant recipients. No damage to renal function was noted when these investigations were performed in patients with normal renal function. In transplanted patients with previous renal insufficiency, arteriographies, even selective, did not seem to be more dangerous than highdose urographies. The degree of seriousness of nephrotoxic accidents seems to be increased when the iodine dose is more than 1 g/kg b.w. and when the investigations are repeated within short intervals.

The authors report a new case of acute renal insufficiency with Rifampicin. They evoke the clinical background which is characteristic of these anuric tubular nephritis. They recall the different complications with Rifampicin to which they can be associated and the different mechanisms which can be at the origin of this affection as well as the difficulties to reveal them. Then, they insist on the prevention of renal accidents within the frame of our present knowledge.

15 cases of acute renal failure following ingestion of bichloride of mercury were studied at Pahlavi medical center, university of Teheran, between 1962 and 1972. All the patients admitted suicide attempts. All had oliguria and uremia except one, in whom oliguria was moderate without azotemia. There were four deaths among the 15 patients, three of them with gastrointestinal hemorrhage; secondery infection and the prolonged acute uremia probably were the cause of death in another one. Early administration of B. A. L. and early frequent hemodialysis helps to support the patient through the period of oliguria and possibly to remove the mercury B.A.L. Complex. Although the mortality of mercury intoxication has decreased, gastrointestinal hemorrhages and secondery infections make its prognosis still unfavorable.

A 75 year old man, treated with ajmaline, was admitted with malaise, fever, acute renal failure and cholestatic jaundice. Haemolytic anaemia and thrombocytopaenia were also found with a positive indirect Coomb's test in the presence of ajmaline. The immunological and haematological data are discussed in the light of previously published cases.