Penicillamine and The Nephrotic Syndrome

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.³

If pyridoxine deficiency does prove to be a contributing factor in the renal pathology