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Penicillamine and The Nephrotic Syndrome FREE

Mildred S. Seelig, MD
JAMA. 1967;199(10):767-767. doi:10.1001/jama.1967.03120100129039
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To the Editor:—  Dr. Sternlieb's article on penicillamine and the nephrotic syndrome (198:1311, 1966) was extremely interesting. The trouble he took to trace the isomer used, showing that only the DL form was implicated in each instance, is an important contribution.Whether pyridoxine inhibition may indeed have been involved in this nephropathology should still be considered. Agnew1 described histologic lesions, which included glomerular lesions, subcapsular amorphous material, fibrosis, and dilatation, in pyridoxine-deficient rats. These changes are similar to those seen in the renal biopsy specimens, and reported by Adams et al.2 It is of interest, also, that Adams' patient had a desquamative rash throughout her course of penicillamine therapy. Scaly skin has long been associated with B6 deficiency in rats, and has more recently been produced in normal men given desoxypyridoxine.3If pyridoxine deficiency does prove to be a contributing factor in the renal pathology

REFERENCES

Agnew, L.R.C.:  Renal Lesions in Pyridoxine-Deficient Rats , J Path Bact 63:699, 1951;.
Adams, D.A., et al:  Nephrotic Syndrome Associated With Penicillamine Therapy of Wilson's Disease , Amer J Med 36:330-336 ( (Feb) ) 1964;.
Hodges, R.E., et al:  Factors Affecting Human Antibody Response: IV. Pyridoxine Deficiency , Amer J Clin Nutr 2:180-199 ( (Sept) ) 1962;.
Asatoor, A.M.:  Pyridoxine Deficiency in the Rat Produced by D-Penicillamine , Nature 203:1382-1383 ( (Sept) ) 1964;.
Jaffe, I.A.; Altman, K.; and Merryman, P.:  The Antipyridoxine Effect of Penicillamine in Man , J Clin Invest 43:1869-1873, 1964;.
Hollister, L.E., et al:  Antipyridoxine Effect of D-Penicillamine in Schizophrenic Men , Amer J Clin Nutr 19:307-312 ( (Nov) ) 1966;.
Gershoff, S.N., et al:  Vitamin B6 Deficiency and Oxalate Nephrocalcinosis in the Cat , Amer J Med 27:72-80 ( (July) ) 1959;.

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Agnew, L.R.C.:  Renal Lesions in Pyridoxine-Deficient Rats , J Path Bact 63:699, 1951;.
Adams, D.A., et al:  Nephrotic Syndrome Associated With Penicillamine Therapy of Wilson's Disease , Amer J Med 36:330-336 ( (Feb) ) 1964;.
Hodges, R.E., et al:  Factors Affecting Human Antibody Response: IV. Pyridoxine Deficiency , Amer J Clin Nutr 2:180-199 ( (Sept) ) 1962;.
Asatoor, A.M.:  Pyridoxine Deficiency in the Rat Produced by D-Penicillamine , Nature 203:1382-1383 ( (Sept) ) 1964;.
Jaffe, I.A.; Altman, K.; and Merryman, P.:  The Antipyridoxine Effect of Penicillamine in Man , J Clin Invest 43:1869-1873, 1964;.
Hollister, L.E., et al:  Antipyridoxine Effect of D-Penicillamine in Schizophrenic Men , Amer J Clin Nutr 19:307-312 ( (Nov) ) 1966;.
Gershoff, S.N., et al:  Vitamin B6 Deficiency and Oxalate Nephrocalcinosis in the Cat , Amer J Med 27:72-80 ( (July) ) 1959;.
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