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A patient with probable pseudo acute renal failure resulting from the effect of cefoxitin on the routine measurement of serum creatinine is described. In vitro studies demonstrate varying degrees of cefoxitin interference with three widely used automated methods for creatinine determination, resulting in falsely elevated levels of this measure of renal function. Care in the interpretation of serum creatinine in patients receiving cefoxitin is advised.

A 61 year old man experienced oliguric acute renal failure during therapy with indomethacin. Proteinuria (5.1 g/24 hours) and hypertension, which accompanied renal insufficiency, cleared with recovery of function. These features may suggest drug-associated acute kidney failure.

A generalized cutaneous hypersensitivity reaction to a porcine heparin preparation was observed in a patient during the course of acute renal failure. Immunological studies, including gel diffusion and immunoelectrophoresis, suggested that the reaction was to a contaminant of the heparin and involved both IgG and IgE antibodies.

Five patients are described in whom only gentamicin sulfate appeared responsible for acute renal failure. Subjects received 1.2 to 2.88 gm over 12 to 18 days. All were over 45 years of age, and premorbid kidney abnormalities may have enhanced susceptibility to toxic effects of the drug. Renal failure appeared 8 to 17 days after beginning gentamicin therapy and was characterized by creatinine clearances 4 to 10 ml/min, urine to plasma creatinine ratios less than 20, urinary sodium concentrations 16 to 60 mEq/liter, proteinuria, and cylindruria. Oliguria was not observed and this feature may impair recognition of kidney damage. Clinical recovery required an average of 42 days and was complete in four of five patients. Gentamicin alone may be nephrotoxic and should be given with particular caution to the elderly and those with even mild kidney abnormalities.