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Acute Renal Failure and Pigmentation Due to Phenazopyridine (Pyridium®)

FILOTEO A. ALANO JR., M.D.; and GEORGE D. WEBSTER JR., M.D., F.A.C.P.
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▸Requests for reprints should be addressed to George D. Webster, M.D., Graduate Hospital, 19th and Lombard Streets, Philadelphia, Pa. 19146


Philadelphia, Pennsylvania


Ann Intern Med. 1970;72(1):89-91. doi:10.7326/0003-4819-72-1-89
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Two patients developed evidence of acute renal failure after receiving larger than recommended doses of phenazopyridine (Pyridium®) for urinary tract analgesia. Both patients had evidence of preexisting renal disease. The patients developed skin pigmentation, pigmentation of the urine, and highly pigmented casts and crystals in the urine sediment. Both had transient oliguria and impaired renal function. One patient died suddenly from pulmonary embolus: Postmortem examination showed pigmented tubular casts and degenerative and regenerative changes in the epithelial cells of the collecting ducts. The localization of the lesions was similar to that reported in studies of phenazopyridine toxicity. Phenazopyridine should be used with caution and in reduced doses in patients with evidence of renal impairment.

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