Nephritis serum proteins

The answer is b. (Hardman, p 1077.) Oxacillin is classified as a penicillinase-resistant penicillin that is relatively acid-stable and, therefore, is useful for oral administration. Major adverse reactions include penicillin hypersensitivity and interstitial nephritis. With the exception of methi-cillin, which is 35% bound to serum proteins, all penicillinase-resistant penicillins are highly bound to plasma proteins. Oxacillin has a very narrow spectrum and is used primarily as an anti staphylococcal agent... 

In 1912 Epstein (86) called attention to the striking fall in serum albumin and total serum protein levels in what was then designated chronic parenchymatous nephritis. To explain the marked accompanying edema, Epstein (87) in 1917 applied the Starling concept (331) of the... 

Since the preparations are raised in heterologous species, reactions against the foreign proteins may lead to serum sickness and nephritis. The concomitant use of corticosteroids may alleviate this response. 

Tetracyclines not uncommonly cause a raised serum urea concentration due to impaired protein synthesis rather than renal damage. However, renal insufficiency can occur, and patients with pre-existing renal insufficiency are particularly likely to develop raised blood urea nitrogen, serum phosphate, and serum sulfate concentrations during treatment with most tetracyclines. These changes may be associated with acidosis and even symptoms of uremia. Renal dysfunction can be missed if diuresis alone is monitored, since non-ohgnric renal insnfficiency has been reported (108). Interstitial nephritis is extremely rare (109-111). 

A 5-year-old boy with a neuroblastoma was treated in the same way. On day 105 after bone-marrow transplantation he developed hypertension (BP 140/92 mmHg), hematuria, proteinuria, and a raised serum creatinine. His hemoglobin and platelet count fell. His urine contained protein 800 mg/1, a few hyaline casts, and 25-30 erythrocytes per high-power field. When nephritis developed, cw-retinoid acid was withdrawn. He gradually improved, and his urine cleared of casts, erythrocytes, and protein within 4 weeks. 

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