RT Journal
A1 Whelton A
T1 EXacerbation of renal failure with doxycycline use
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1979
FD May 1
VO 139
IS 5
SP 603
OP 604
DO 10.1001/archinte.1979.03630420089033
UL http://dx.doi.org/10.1001/archinte.1979.03630420089033
AB To the Editor.— 
    The temporally related exacerbation of renal failure associated with doxycycline use, as reported by Dr Orr and colleagues in the Archives (138:793-794, 1978), is certainly of interest and importance. However, the report serves to emphasize the caution with which one should interpret such clinical findings in the absence of pertinent serum drug concentration data and the intercurrent use of other potent compounds that influence renal function.The case report indicates that, after doxycycline therapy, the patient in question received a potent diuretic twice daily at a time when she exhibited peripheral edema. She subsequently manifested evidence of fluid depletion and mild postural hypotension. The contribution of doxycycline to the pathogenesis of the patient's fluid depletion must remain speculative at best. It is perhaps worth noting that it is almost invariably the demethylchlortetracycline form of tetracycline that produces direct renal tubular concentration effects.1-3 The role of the