Nephrotic Syndrome Following Topically Applied Sulfadiazine Silver Therapy

A severely burned patient developed heavy proteinuria, hematuria, eosinophilia, and azotemia after receiving topical therapy with sulfadiazine silver. A renal biopsy specimen revealed interstitial nephritis and intramembranous electron-dense deposits in the glomerular basement membrane, suggesting an immune-complex mechanism of renal injury. Improved renal function and remission of proteinuria occurred after five months of therapy with immunosuppressive agents. Although renal injury following sulfonamide administration orally is well-known, there are, to our knowledge, no reports of the nephrotic syndrome in association with topical therapy with sulfonamides.