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High-dose antioxidant therapy and steroids might improve the outcome of acute renal failure from intoxication by Cortinarius rubellus: report of two cases.

Kerschbaum J, Mayer G, Maurer A - Clin Kidney J (2012)

Bottom Line: Only a small number of cases with favourable outcome after acute renal failure due to intoxication by Cortinarius sp. have been reported in the literature, and approximately half of the patients develop chronic renal failure and dialysis-dependency.Dialysis was never necessary in both patients and renal function was almost normal at the end of follow-up.Early treatment with high-dose antioxidant therapy and steroids might be effective in reducing the risk of chronic renal failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine IV (Nephrology and Hypertension) , Medical University Innsbruck , Innsbruck , Austria.

ABSTRACT
Only a small number of cases with favourable outcome after acute renal failure due to intoxication by Cortinarius sp. have been reported in the literature, and approximately half of the patients develop chronic renal failure and dialysis-dependency. We report the case of a couple with acute renal failure after accidental intake of Cortinarius rubellus and a favourable outcome after treatment with high-dose antioxidant therapy with N-acetylcysteine and steroids. Dialysis was never necessary in both patients and renal function was almost normal at the end of follow-up. Underdiagnosis of this rare cause of acute renal failure is likely due to the fact that affected patients develop symptoms of intoxication after a delay of 2-30 days. In patients with unclear acute renal failure with or without gastrointestinal symptoms, intoxication from Cortinarius sp. should be considered as a differential diagnosis. Early treatment with high-dose antioxidant therapy and steroids might be effective in reducing the risk of chronic renal failure.

No MeSH data available.


Related in: MedlinePlus

Kidney biopsy specimen in light microscopy (PAS). Glomeruli (not shown) were normal.
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SFS129F1: Kidney biopsy specimen in light microscopy (PAS). Glomeruli (not shown) were normal.

Mentions: A 62-year-old woman was transferred to our nephrology unit from a peripheral hospital due to acute renal failure of unknown origin. Four days before admission she complained of nausea, vomiting and an epigastric feeling of pressure. The patient denied any recent consumption of nephrotoxic drugs. However, two days prior to the onset of symptoms she and her husband had picked, cooked and eaten wild mushrooms, which she had taken for mushrooms called Cantharellus cibarius. Both of them were rather inexperienced in mushroom picking. Immediately, the husband was informed about the suspected diagnosis of mushroom poisoning. On pictures shown to them, they positively identified a Cortinarius sp., which they had taken for chanterelles (Cantharellus cibarius). In the female patient, a physical examination showed an elevated blood pressure of 160/77 mmHg, a body temperature of 37.5°C and a pulse rate of 52. The patient was in a reduced general condition and had epigastric pain. Laboratory tests revealed anaemia (haemoglobin 11.5 g/dL), serum creatinine of 587.0 µmol/L (6.64 mg/dL) and urea of 28.2 mmol/L (169.5 mg/dL). Levels of potassium, chloride and phosphate were also increased. In addition, laboratory tests showed the following liver function parameters: glutamate oxaloacetate transaminase 65 U/L, glutamate pyruvate transaminase 61 U/L and gamma-glutamyl transferase 74 U/L. The protein-to-creatinine ratio in urine was 0.59 mg/g. Immunological parameters and virological tests were all negative. A renal ultrasound showed no specific abnormalities and the kidneys were of normal size. A renal biopsy was performed 2 days after admission. Histological examination by light microscopy showed acute interstitial nephritis of lymphomononuclear type and globally preserved glomeruli (Figure 1). Higher magnification of the tubulointerstitium revealed tubular dystrophy with anisometric vacuolization, loss of brush border membranes and debris in the tubular lumina. There could be seen a moderate acute tubular damage and minimal acute non-destructive tubulointerstitial nephritis, probably due to orellanus toxicity. Thin-layer chromatography of a properly processed biopsy specimen as previously described failed to detect the toxin orellanin.Fig. 1.


High-dose antioxidant therapy and steroids might improve the outcome of acute renal failure from intoxication by Cortinarius rubellus: report of two cases.

Kerschbaum J, Mayer G, Maurer A - Clin Kidney J (2012)

Kidney biopsy specimen in light microscopy (PAS). Glomeruli (not shown) were normal.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400554&req=5

SFS129F1: Kidney biopsy specimen in light microscopy (PAS). Glomeruli (not shown) were normal.
Mentions: A 62-year-old woman was transferred to our nephrology unit from a peripheral hospital due to acute renal failure of unknown origin. Four days before admission she complained of nausea, vomiting and an epigastric feeling of pressure. The patient denied any recent consumption of nephrotoxic drugs. However, two days prior to the onset of symptoms she and her husband had picked, cooked and eaten wild mushrooms, which she had taken for mushrooms called Cantharellus cibarius. Both of them were rather inexperienced in mushroom picking. Immediately, the husband was informed about the suspected diagnosis of mushroom poisoning. On pictures shown to them, they positively identified a Cortinarius sp., which they had taken for chanterelles (Cantharellus cibarius). In the female patient, a physical examination showed an elevated blood pressure of 160/77 mmHg, a body temperature of 37.5°C and a pulse rate of 52. The patient was in a reduced general condition and had epigastric pain. Laboratory tests revealed anaemia (haemoglobin 11.5 g/dL), serum creatinine of 587.0 µmol/L (6.64 mg/dL) and urea of 28.2 mmol/L (169.5 mg/dL). Levels of potassium, chloride and phosphate were also increased. In addition, laboratory tests showed the following liver function parameters: glutamate oxaloacetate transaminase 65 U/L, glutamate pyruvate transaminase 61 U/L and gamma-glutamyl transferase 74 U/L. The protein-to-creatinine ratio in urine was 0.59 mg/g. Immunological parameters and virological tests were all negative. A renal ultrasound showed no specific abnormalities and the kidneys were of normal size. A renal biopsy was performed 2 days after admission. Histological examination by light microscopy showed acute interstitial nephritis of lymphomononuclear type and globally preserved glomeruli (Figure 1). Higher magnification of the tubulointerstitium revealed tubular dystrophy with anisometric vacuolization, loss of brush border membranes and debris in the tubular lumina. There could be seen a moderate acute tubular damage and minimal acute non-destructive tubulointerstitial nephritis, probably due to orellanus toxicity. Thin-layer chromatography of a properly processed biopsy specimen as previously described failed to detect the toxin orellanin.Fig. 1.

Bottom Line: Only a small number of cases with favourable outcome after acute renal failure due to intoxication by Cortinarius sp. have been reported in the literature, and approximately half of the patients develop chronic renal failure and dialysis-dependency.Dialysis was never necessary in both patients and renal function was almost normal at the end of follow-up.Early treatment with high-dose antioxidant therapy and steroids might be effective in reducing the risk of chronic renal failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine IV (Nephrology and Hypertension) , Medical University Innsbruck , Innsbruck , Austria.

ABSTRACT
Only a small number of cases with favourable outcome after acute renal failure due to intoxication by Cortinarius sp. have been reported in the literature, and approximately half of the patients develop chronic renal failure and dialysis-dependency. We report the case of a couple with acute renal failure after accidental intake of Cortinarius rubellus and a favourable outcome after treatment with high-dose antioxidant therapy with N-acetylcysteine and steroids. Dialysis was never necessary in both patients and renal function was almost normal at the end of follow-up. Underdiagnosis of this rare cause of acute renal failure is likely due to the fact that affected patients develop symptoms of intoxication after a delay of 2-30 days. In patients with unclear acute renal failure with or without gastrointestinal symptoms, intoxication from Cortinarius sp. should be considered as a differential diagnosis. Early treatment with high-dose antioxidant therapy and steroids might be effective in reducing the risk of chronic renal failure.

No MeSH data available.


Related in: MedlinePlus