Antioxidant treatment and outcome ofcortinarius orellanuspoisoning: a case series

Abstract

Objectives: To study the frequency, severity, and long-term outcome of renal injury in Cortinarius orellanus poisoning, to evaluate the association between the ingested amount of C. orellanus and outcome, and to evaluate the effect of N-acetylcysteine and corticosteroid treatment on outcome. Methods: Case series of eight patients. Diagnosis and severity of acute kidney injury (AKI) and chronic kidney disease (CKD) were classified according to current AKI and CKD definitions. N-acetylcysteine and corticosteroids were administered to six patients, former according to the standard for paracetamol poisoning. Main findings: All patients developed AKI, six in the most severe stage and four required renal replacement therapy (RRT). After 12 months, seven patients presented with CKD, of whom three required chronic RRT and further two were in advanced CKD. AKI and CKD severity highly correlated with the consumed amounts of Cortinarius orellanus (r ¼ 0.98, p50.001 and r ¼ 0.78, p ¼ 0.02, respectively) but not with N-acetylcysteine and corticosteroid treatment. Conclusions: AKI and CKD by current definitions and classifications are frequent and severe after Cortinarius orellanus poisoning. The ingested amount of Cortinarius orellanus correlates with the severity of both AKI and CKD. N-acetylcysteine and corticosteroid treatment do not seem to have a beneficial effect on either AKI or CKD.

Bardoxolone methyl: drug development for diabetic kidney disease

“…Several clinical trials conducted to date in the US and Europe have been designed to explore the effects of antioxidants such as vitamin E, N-acetyl cysteine and coenzyme Q10 to treat kidney diseases [10][11][12]. However, these studies had a relatively small sample size for a clinical study design, and the results were contradictory.…”

Orellanine: From Fungal Origin to a Potential Future Cancer Treatment

“…Many patients only present for treatment following the onset of renal symptoms, at which stage mushroom poisoning is no longer an obvious cause. , At this stage, orellanine will no longer be detectable in the plasma, , with analysis of renal tissue samples currently the only method to confirm a diagnosis of orellanine poisoning . There is currently no antidote or curative treatmentthere have been suggestions that the use of high dose antioxidants with or without steroids may improve outcomes, − but such a strategy has failed to produce consistently reproducible results . Standard therapy focuses on dialysis, to relieve pressure on the kidneys and maximize their chances of recovery. ,, Attempts to counteract the oxidative damage with administration of superoxide dismutase (SOD) led to increased toxicity in rat models .…”

Six groups of poisonous mushrooms: classified according to clinical symptoms

“…It is linked to some Cortinarius species, particularly those that contain orellanine [5]. The clinical manifestation of this kind of poisoning is delayed onset renal failure, which develops 4-15 days after intake [5,6,7,8,9,10]. Pre-renal symptoms may manifest 12 hours to 14 days after swallowing the chemical and include nausea, vomiting, diarrhoea, dehydration, thirst, anorexia, headaches, chills, parasthesia, sleepiness, sweating, rash, dyspnea, and lumbar pain (mean 3 days) [5,7].…”