Observations during treatment of cystinuria with D-penicillamine.

. Three patients with severe stone-producing cystinuria have been treated with d-penicillamine for altogether 68 patient-months. The treatment was effective in all instances, but serious complications ensued in two patients. One patient acquired a severe nephrotic syndrome and laboratory signs of systemic lupus erythematosus. This patient is probably the first described with both these complications, and possibly also the first described cysunuric developing SLE from penicillamine. Another patient used the drug throughout pregnancy and gave birth to a child with a generalized connective tissue defect, probably caused by penicillamine dissolution of fetal collagen. This patient seems also to be the first described of the kind. Before d-penicillaminc is used in the therapy of cystinuria, one should ascertain that other measures have been used to their full extent. Treatment with d-penicillamine requires meticulous control in order to detect complications at the earliest possible stage.