Nephrotoxicity associated with the use of cephalosporin antibiotics is an infrequent occurrence with the exception of cephaloridine, which has been implicated in a substantial number of cases of acute renal failure.1 In particular, sodium cephalothin (Keflin) is frequently alluded to as a potent penicillinase resistant antibiotic with low or unproven nephrotoxicity. There have been isolated cases of renal failure reported due to or associated with cephalothin administration, usually in patients with preexisting renal impairment and other drug therapy.2-11 The case reported herein also represents renal failure associated with cephalothin therapy. Renal biopsy findings with electron microscopy studies in this setting are described.
A 53-year-old man was admitted to the San Francisco Veterans Administration Hospital for treatment of an infected scalp laceration. He had been admitted many times previously for illnesses related to alcohol ingestion, such as bleeding duodenal ulcer, multiple fractures, and peripheral neuropathy. The injury