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Tetracycline and Rises in Urea Nitrogen

A. M. Tannenberg, MD
JAMA. 1972;221(7):713. doi:10.1001/jama.1972.03200200059022.
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To the Editor.—  I must take exception to several points made in the article entitled "Tetracycline and Drug Attributed Rises in Blood Urea Nitrogen" reported by the Boston Collaborative Drug Surveillance Program in the April 17th issue of The Journal (220:377, 1972).In the initial statement, the authors fail to clearly define what is meant by "clinically significant rises in BUN level." This point is crucial since, as Dosseter1 has clearly shown, one may have wide variations in blood urea nitrogen (BUN) levels just on the basis of variation in protein metabolism without any variation in overall renal function or any clinical symptoms. Furthermore, there is no evidence that urea per se is toxic. It has been used and still is used on occasion as an osmotic diuretic. Secondly, it would have been helpful to mention the types of diuretics involved since some are known to adversely affect the


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