The pharmacokinetics of ciprofloxacin were studied, in six healthy controls and in 18 patients with varying degrees of renal impairment, after administration of a single 100 mg intravenous dose. Pharmacokinetic parameters were calculated on a two compartment open model. The mean distribution volume was 2.1 (+/- 0.6) l/kg of ideal body weight; it did not correlate significantly with renal function. In the healthy volunteers 57 (+/- 9)% of the drug was eliminated by the kidney and 43% by other pathways. The renal clearance of ciprofloxacin correlated with creatinine clearance (rs = 0.93, P less than 0.001), and urinary excretion of the drug was markedly reduced in patients with the most severe degrees of renal impairment. Plasma clearance correlated with creatinine clearance (rs = 0.50, P less than 0.02). This together with the lack of correlation between non-renal clearance and renal function enables us to suggest an intravenous dosage schedule for patients with renal impairment.

The plasma protein binding of metoclopramide was measured after addition of the drug (60 ng ml‐1) to plasma from 18 patients with renal disease and 18 age and sex matched healthy individuals. The mean free fraction in renal disease (0.59 range 0.41‐0.71) was not significantly different from controls (mean 0.6 range 0.56‐0.69). In both groups the binding ratio of metoclopramide was significantly related to plasma alpha 1‐acid glycoprotein (AAG) concentration but not to albumin or plasma non‐esterified fatty acids concentration. Metoclopramide bound to human serum albumin (HSA) to a limited extent and to human AAG to a greater extent indicating that AAG is the major binding protein for the drug in plasma.

Patients from a renal transplantation unit with an unusually high incidence of polycythaemia were divided into polycythaemic and control groups. The rate of rise of haemoglobin concentration was not significantly different in the two groups. The polycythaemic group received a significantly lower dose of azathioprine (p < 0.005) and included more patients with polycystic disease than the control group (p < 0.05). An effect of azathioprine on bone marrow function was suggested by the polycythaemic group also having a higher mean white cell count (p < 0.02). Azathioprine dosage correlated negatively with post-transplantation polycythaemia regardless of the original cause of renal failure.

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A 29 year old man was admitted 36 hours after ingesting about 5 g paraquat. His arterial oxygen pressure fell progressively to 3-4 kPa (34 mm Hg), and pulmonary damage induced by paraquat was diagnosed. His condition did not improve after treatment with prednisolone and cyclophosphamide, but after irradiation both lungs cleared and arterial oxygen pressure started to improve.