amatoxin and Acute-Kidney-Injury

Amanita neoovoidea (genus Amanita Pers.) poisoning leads to acute renal failure. Here, we present seven case reports of acute renal failure with acute hepatic failure due to ingestion of A. neoovoidea. Clinical manifestations included gastrointestinal symptoms 1-72 h after ingestion; elevation of renal parameters and blood uric acid, blood urea nitrogen, and creatinine levels; a few abnormal hepatic parameters, primarily albumin decrease and alanine aminotransferase increase; and elevation of zymogram parameters such as cholinesterase and lactate dehydrogenase. To determine whether the hepatic/renal lesions were caused by amanitins, we analyzed the blood and urine samples of patients and specimens of poisonous mushrooms. Morphological and molecular biological analyses indicated that the mushroom was A. neoovoidea. However, no amatoxins and phallotoxins were detected in its basidiomata.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Amanita; Amanitins; Blood Urea Nitrogen; China; Chromatography, High Pressure Liquid; Creatinine; Female; Humans; Male; Middle Aged; Mushroom Poisoning; Uric Acid

A 60-year-old man presented with acute gastroenteritis, hypovolemic shock, acute renal failure (BUN/Cr, 56.7/4.24 mg/dl), and aspiration pneumonia. The previous day, he ingested 30 caps of mushrooms of an unknown species. The patient was treated with a massive intravenous infusion, renal replacement therapy, and antimicrobial agents. Late-onset mild liver injury peaked on day 11 (AST/ALT, 62/67 IU/l). Acute renal failure improved once before worsening, with the worst symptoms on day 19 (BUN/Cr, 99/6.61 mg/dl). Thereafter, the patient showed gradual improvement, and renal replacement therapy was discontinued on day 23. His general condition improved fully and he was transferred to another hospital for rehabilitation on day 47. The mushrooms were later identified as Galerina sulciceps by the Basic Local Alignment Search Tool, and toxicologic analysis using liquid chromatography-tandem mass spectrometry revealed an average of 85 ppm α-amanitin and 330 ppm β-amanitin in the tissue of the mushrooms brought in by the patient's family. Galerina sulciceps is distributed mainly in tropical and subtropical regions of Southeast Asia and had never been identified before in Japan. The heat of fermentation generated by the thick layer of wood chips on the ground or global warming may have contributed to its growth in Japan. Interestingly, our patient did not have liver dysfunction, which is one main and typical amatoxin poisoning symptom. Variation in clinical presentation may be attributed to the different ratios of α-amanitin to β-amanitin in different mushroom species.

Topics: Acute Kidney Injury; Agaricales; Alpha-Amanitin; Amanitins; Humans; Japan; Male; Middle Aged; Mushroom Poisoning

Experiences of liver transplantation after Amanita phalloides poisoning were analysed in anaesthetic and intensive therapist point of view based on 3 cases. Cardiac problems were found at all patients during the postoperative period. Probably the amatoxin has cardiotoxic effect or a part of phallotoxins are absorbed despite cooking and caused reversible cardiac function impairment. Pancreatitis, DIC, gastrointestinal bleeding, acute renal failure were found at all patients, therefore liver transplantation is only a part of the treatment, complex therapy is necessary in this cases.

Topics: Acute Kidney Injury; Adult; Amanita; Amanitins; Anesthesia, General; Child; Combined Modality Therapy; Critical Care; Disseminated Intravascular Coagulation; Electrocardiography; Gastrointestinal Hemorrhage; Heart Conduction System; Humans; Liver Failure; Liver Transplantation; Male; Mushroom Poisoning; Pancreatitis

Ingestion of mushrooms followed after 6-12 hours by gastrointestinal symptoms and after 3-4 days by hepatic symptoms is diagnostic for the life-threatening amatoxin intoxication and should be treated as soon as possible. Four case histories are reported and recommendations for treatment are given.

Topics: Acute Kidney Injury; Adult; Amanita; Amanitins; Combined Modality Therapy; Female; Humans; Liver Function Tests; Male; Middle Aged; Mushroom Poisoning

Four incidents of mushroom poisoning, representing four of the seven established groups of toxic mushrooms, are presented. These case reports illustrate the range of gastrointestinal and neurological symptoms caused by mushroom poisoning and reflect a nationwide increase in reports of serious poisonings in recent years. Severity of poisonings often parallels the time span between consumption and onset of symptoms, with serious poisonings having longer incubation periods. New therapies for amatoxin poisoning may reduce mortality caused by these poisonings.

Topics: Acute Kidney Injury; Adult; Aged; Amanitins; Child; Diarrhea; Female; Hallucinations; Humans; Male; Middle Aged; Mushroom Poisoning; New York; Respiratory Distress Syndrome; Thioctic Acid; Time Factors