Reversible encephalopathy and acute renal failure after cephaloridine.

was 12-2 g./100 ml. Blood urea was 54 mg./100 ml. I.V.P. showed a normal upper tract and a filling defect in the bladder. At cystoscopy two tumours above the left ureteric orifice were seen and fulgurated. Histology showed transitional cell papillary carcinoma. No recurrence has arisen. After cystoscopy several urinary tract infections, usually with Escherichia coli, were treated with ampicillin or chloramphenicol. Continuous therapy became necessary. In January 1968 investigation revealed blood urea 120 mg./100 ml.; creatinine clearance 22 ml./min.; renal biopsy: compatible with chronic pyelonephritis; urine culture: E. coli. Eight parenteral courses of antibiotics, including cephaloridine, were given over the next six months, but relapse invariably ensued with the same strains of E. coli, the drug sensitivity pattern being unchanged. High-dosage therapy was begun, using cephaloridine 8 g./day (160 mg./kg. body weight/day) intravenously for 12 days, then 4 g. daily intramuscularly for two days. On the 13th day she vomited and rapidly became semiconscious. Blood urea 170 mg./100 ml.; creatinine 6-4 mg./100 ml.; 24-hour urine volume 750 ml. On the 14th day the blood cephaloridine level was 35 jsg./ml. and the C.S.F. cephaloridine level was 6-4 ug./mL A cerebral abscess was thought possible. Carbenicillin and cloxacillin were added and cephaloridine was withdrawn (see Chart).