Advertisement

Pediatric Nephrology

, Volume 21, Issue 11, pp 1760–1764 | Cite as

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

  • Ali Mirza OnderEmail author
  • Veronica Espinoza
  • Mariana E. Berho
  • Jayanthi Chandar
  • Gaston Zilleruelo
  • Carolyn Abitbol
Brief Report

Abstract

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.

Keywords

Pyridium® intoxication Acute renal failure Methemoglobinemia 

References

  1. 1.
    Perazella M (2003) Drug-induced renal failure: update on new medications and unique mechanisms of nephrotoxicity. Am J Med Sci 325:349–362CrossRefGoogle Scholar
  2. 2.
    Gould S (1975) Urinary tract disorders. Clinical comparison of flavoxate and phenazopyridine. Urology 5:612–615CrossRefGoogle Scholar
  3. 3.
    Alano FA, Webster GD (1970) Acute renal failure and pigmentation due to phenazopyridine. Ann Intern Med 72:89–91CrossRefGoogle Scholar
  4. 4.
    Qureshi N, Hedser RW (1979) Phenylazopyridine (Pyridium®) and acute renal failure. Ann Intern Med 90:443CrossRefGoogle Scholar
  5. 5.
    Feinfeld DA, Rainer R, Lipner HI, Avram MM (1978) Renal failure in phenazopyridine overdose. JAMA 240:2661CrossRefGoogle Scholar
  6. 6.
    Vega J (2003) Acute renal failure caused by phenazopyridine. Rev Med Chil 131:541–544PubMedGoogle Scholar
  7. 7.
    Rule KA, Biggs AW (1984) Transient renal failure following phenazopyridine overdose. Urology 24:178–179CrossRefGoogle Scholar
  8. 8.
    Nathan DM, Siegel AJ, Bunn HF (1977) Acute methemoglobinemia and hemolytic anemia with phenazopyridine. Arch Intern Med 137:1636–1638CrossRefGoogle Scholar
  9. 9.
    Rivas R, Martinez TA, Bohorques R, Martinez AI (2001) Acute kidney failure caused by phenazopyridine overdose. Nefrologia 21:97–98PubMedGoogle Scholar
  10. 10.
    Mason AD, Teschan PE, Colonel LT, Muirhead EE (1963) Renal histologic alterations in acute renal failure in the rat. J Surg Res 3:450–456CrossRefGoogle Scholar
  11. 11.
    Wander HJ, Pascoe DJ (1965) Phenylazopyridine hydrochloride poisoning. Am J Dis Child 110:105–107CrossRefGoogle Scholar
  12. 12.
    Crawford SE, Moon AE, Panos TC, Hooks CA (1951) Methemoglobinemia associated with Pyridium® administration; report of a case. JAMA 146:24–25CrossRefGoogle Scholar
  13. 13.
    Sand RE, Edelman CM (1961) Pyridium®-induced methemoglobinemia. Report of a case. J Pediatr 58:845–848CrossRefGoogle Scholar
  14. 14.
    Greenberg M, Wong H (1964) Methemoglobinemia and Heinz body hemolytic anemia due to phenazopyridine hydrochloride. N Engl J Med 271:431–435CrossRefGoogle Scholar
  15. 15.
    Fincher ME, Campbell HT (1989) Methemoglobinemia and hemolytic anemia after phenazopyridine hydrochloride (Pyridium®) administration in end-stage renal disease. South Med J 82:372–374CrossRefGoogle Scholar
  16. 16.
    Johnson WJ, Chartrand A (1976) The metabolism and excretion of phenazopyridine hydrochloride in animals and man. Toxicol Appl Pharmacol 37:371–376CrossRefGoogle Scholar
  17. 17.
    Green ED, Zimmerman RC, Ghurabi WH, Colohan DP (1979) Phenazopyridine hydrochloride toxicity: a cause of drug-induced methemoglobinemia. JACEP 8:426–431CrossRefGoogle Scholar
  18. 18.
    Gavish D, Knobler H, Gottehrer N, Israeli A, Kleinman Y (1986) Methemoglobinemia, muscle damage, and renal failure complicating phenazopyridine overdose. Isr J Med Sci 22:45–47PubMedGoogle Scholar
  19. 19.
    Walton RP, Lawson EH (1934) Pharmacology and toxicology of the azo dye, phenylazo-alpha-alpha-diaminopyridine (Pyridium®). J Pharmacol Exp Ther 51:200–216Google Scholar
  20. 20.
    Bradberry SM (2003) Occupational methemoglobinemia. Mechanisms of production, features, diagnosis and management including the use of methylene blue. Toxicol Rev 22:13–27CrossRefGoogle Scholar
  21. 21.
    Munday R, Fowke EA (1994) Generation of superoxide radical and hydrogen peroxide by 2,3,6-triaminopyridine, a metabolite of the urinary tract analgesic phenazopyridine. Free Radic Res 21:67–73CrossRefGoogle Scholar
  22. 22.
    Kearney TE, Manoguerra AS, Dunford JV (1984) Chemically induced methemoglobinemia from aniline poisoning. West J Med 140:282–286PubMedPubMedCentralGoogle Scholar
  23. 23.
    Hood JW, Tooth WN (1966) Jaundice caused by phenazopyridine hydrochloride. JAMA 198:1366–1367CrossRefGoogle Scholar
  24. 24.
    Eybel CE, Armstrong KF, Ing TS (1974) Skin pigmentation and acute renal failure in a patient receiving phenazopyridine therapy. JAMA 228:1027–1028CrossRefGoogle Scholar
  25. 25.
    Maples KR, Eyer P, Mason RP (1990) Aniline-, phenylhydroxylamine-, nitrosobenzene-, and nitrobenzene-induced hemoglobin thiyl free radical formation in vivo and in vitro. Mol Pharmacol 37:311–318PubMedGoogle Scholar
  26. 26.
    Eaton JW, Leida MN (1985) Hemolysis in chronic renal failure. Semin Nephrol 5:133–139PubMedGoogle Scholar
  27. 27.
    Smith RP, Olson MV (1973) Drug-induced methemoglobinemia. Semin Hematol 10:253–268PubMedGoogle Scholar
  28. 28.
    Sharon M, Puente G, Cohen LB (1986) Phenazopyridine (Pyridium®) poisoning: possible toxicity of methylene blue administration in renal failure. Mt Sinai J Med 53:280–282PubMedGoogle Scholar
  29. 29.
    Nitescu N, Ricksten S-E, Marcussen N, Haraldsson B, Nilsson U, Basu S, Guron G (2006) N-acetylcysteine attenuates kidney injury in rats subjected to renal ischaemia-reperfusion. Nephrol Dial Transplant 21:1240-1247CrossRefGoogle Scholar
  30. 30.
    Mister M, Noris M, Szymczuk J, Azzollini N, Aiello S, Abbate M, Trochimowicz L, Gagliardini E, Arduini A, Perico N, Remuzzi G (2002) Propionyl-L-carnitine prevents renal function deterioration due to ischemia/reperfusion. Kidney Int 61:1064–1078CrossRefGoogle Scholar
  31. 31.
    Tomlinson B, Cohen SL, Smith MR, Fisher C (1983) Nephrotoxicity of phenazopyridine. Hum Toxicol 2:539–543CrossRefGoogle Scholar

Copyright information

© IPNA 2006

Authors and Affiliations

  • Ali Mirza Onder
    • 1
    Email author
  • Veronica Espinoza
    • 2
  • Mariana E. Berho
    • 3
  • Jayanthi Chandar
    • 1
  • Gaston Zilleruelo
    • 1
  • Carolyn Abitbol
    • 1
  1. 1.Department of Pediatrics, Division of Pediatric NephrologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Pediatrics, Division of Pediatric Immunology and Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of PathologyUniversity of Miami Miller School of MedicineMiamiUSA

Personalised recommendations