Malathion Exposure Associated With Acute Renal Failure

To the Editor.— Organophosphates, basic ingredients of common garden insecticides, have not been associated with renal toxicity in humans.1,2We wish to report a case of acute renal insufficiency with massive proteinuria after exposure to the organophosphate malathion. Report of a Case.— A 65-year-old man was admitted to the hospital because of swelling of his legs. Four weeks before admission, he began spraying intensively with malathion and noted intermittent inhalation and skin exposure. Three weeks before admission, he noted an increase in weight and, subsequently, peripheral edema. He had a five-year history of diabetes mellitus treated with insulin. He intermittently took cimetidine for dyspepsia. He denied use of nonsteroidal anti-inflammatory agents. Physical examination disclosed a BP of 150/95 mm Hg, no diabetic retinopathy, gross peripheral edema, and the following values: creatinine, 5.0 mg/dL; serum urea nitrogen, 50 mg/dL; cholesterol, 388 mg/ dL; and albumin, 1.8 g/dL. Urinalysis revealed 4+