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Dr. Colmar Niederstadt, Department of Internal Medicine, Medical University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck (Germany) From days 4-18 after intoxication, we repeatedly measured the urinary concentration of immunoglobulin G, albumin, < xi-microglobulin and endogenous creatinine clearance (fig. 1). Ethylene glycol itself is probably not nephrotoxic, but in the metabolism of ethylene glycol, glycolate and oxalate are generated (fig. 2). Glycolate causes a metabolic Dear Sir, Acute renal failure is one of the major complications in ethylene glycol intoxication [1]. To describe the functional relevance of histologically proven glomerular and tubular damage in ethylene glycol intoxication, we serially measured glomerular and tubular marker proteins in urine by a highly sensitive immunoluminometric assay [2] in a patient with ethylene glycol intoxication. A 22-year-old man drank about 500 ml of rye (40 vol% ethanol), and afterwards ingested 100200 ml of ethylene glycol. Five hours after ingestion, vomiting was induced by syrup of ipecac in order to achieve primary elimination of ethylene glycol. Afterwards, forced diuresis was started (about 400 ml/h) and ethanol was administered continuously. A metabolic acidosis was corrected by infusion of 250 mmol sodium bicarbonate. After 36 h serum creatinine rose from 72 to 259 μmol/l and crystalluria was observed. The patient was transfered to our hospital, where hemodialysis was started immediately (bicarbonate dialysis, on first day two times 2.5 h, afterwards daily 3-4 h, blood flow 200 ml/h, PAN dialysator, 1.4 m2). As symptoms of intoxication besides acute renal failure, perimyocarditis and transient palsy of the oculomotory nerves were seen. The acute renal failure was nonoliguric, serum creatinine rose to a peak concentration of 542 μmol/l 7 days after intoxication but returned to 95 μmol/l 22 days after ethylene glycol ingestion. A microscopic erythrocytu-ria was detectable during the first week after intoxication, urinary pH was 6-7. Ultrason-ography showed swollen kidneys with increased cortical echogenicity, a typical picture in ethylene glycol poisoning [3]. 70-1 Days after intoxication Fig. 1. Immunoglobulin G (¤), albumin (O) and αi-microglobulin (αj-MG, •) concentration in urine related to urinary creatinine concentration (mg protein/g creatinine). There is no abnormal IgG excretion, albumin and cti-MG excretion initially exceeded the normal range by 5.5 and 250, respectively, and normalised during the observation period. With recovery of tubular concentrating capacity creatinine clearance (■) improves.