Idiosyncratic renal toxicity

Nephrotic syndrome (proteinuria, edema, hypoalbumine-mia, hyperlipidemia) is a rare and idiosyncratic complication of lithium therapy it usually resolves on withdrawal, and can recur on rechallenge (397,398). Lithium-associated nephrotic syndrome occurred in a 59-year-old woman with lithium toxicity (serum concentration 1.9 mmol/1) whose renal biopsy showed focal segmental glomerulosclerosis. Lithium withdrawal led to resolution of edema and marked improvement in proteinuria and albuminemia (398). 

Early signs of intoxication include ataxia, dysarthria, coarse tremor, weakness, and drowsiness. More advanced toxicity can involve progressively impaired consciousness, neuromuscular irritability (myoclonic jerks), seizures, cardiac dysrhythmias, and renal insufficiency. A reversible Creutzfeldt-Jakob-like syndrome has been described (162). The severity of intoxication depends on both the extent and duration of exposure to raised lithium concentrations, as well as idiosyncratic factors. 

It is incumbent on health professionals to avoid toxic drugs whenever possible. Antibiotics associated with CNS toxicities, usually when not dose-adjusted for renal function, include penicillins, cephalosporins, quinolones, and imipenem. Hematologic toxicities generally are manifested with prolonged use of nafcillin (neutropenia), piperacillin (platelet dysfunction), cefotetan (hypoprothrombinemia), chloramphenicol (bone marrow suppression, both idiosyncratic and dose-related toxicity), and trimethoprim (megaloblastic anemia). Reversible nephrotoxicity classically is associated with aminoglycosides... 

From the clinical point of view the most important side effect is renal damage. Besides the crystallizing of the sulfonamides in the renal tubules, allergic lower nephron nephrosis appears this complication is extremely serious, but very rare. It is still not clear if it is a direct toxic effect or an idiosyncratic reaction. 

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