Опубликовать статью

Информационное партнерство

Инфоресурсы

Контакты

«

Vol. 24, Art. 54 (pp. 729-738)    |    2023       

»

Acute kidney injury in toxicology clinic: the main causes of development in everyday practice

Kuznetsov O.A.1,2, Shilov V.V.1,2, Fedorov A.V.1

1Saint-Petersburg I.I. Dzanelidze research institute of emergency medicine,
2North-Western State Medical University named after I.I. Mechnikov

Brief summary

Acute kidney injury (AKI) is one of the complications in patients with acute poisoning, which aggravates the condition and affects the outcome of acute chemical trauma. Materials and methods. The analysis of 203 cases of AKI development in patients with acute poisoning was carried out. The data on the causes of AKI development in the toxicology clinic are summarized. Results. It was revealed that for the period 2018-2020. the course of poisoning was complicated by the development of AKI in 4.57% of cases (203 patients). The most common cause was poisoning with synthetic drugs, such as methadone, amphetamine, alpha-PVP. The genesis of AKI development was primarily associated with the development of rhabdomyolysis: local (positional compression syndrome), systemic, which developed as a result of the action of these drugs. Also, the development of AKI was noted in poisoning with various psychopharmacological drugs, preparations affecting mainly the cardiovascular system, toxic alcohols and poisons of cauterizing action. In isolated cases, the development of AKI has been reported in cases of poisoning with paracetamol and amanitines. The cause of AKI was a combination of both renal factors (direct nephrotoxicity) and prerenal factors, such as hypovolenemia and long-lasting hypotension. Conclusion. Most often, AKI develops with poisoning with synthetic drugs, psychopharmacological drugs and toxic alcohols. The development of AKI is one of the severe complications of the disease, which leads to an increase in mortality and the need for replacement therapy.


Key words

poisoning; acute kidney injury; pathogenesis

Reference list

1. Polyshin U.S., Sokolov D.V. Naryshenie pochechnoi fynkcii y pacientov v kriticheskom sostoyanii. Vestnik anesteziologii i reanimatologii. 2018; 15 (5): 54-64.


2. Bellomo R., Ronco C., Mehta R. L. et al. Acute kidney injury in the ICU: from injury to recovery: reports from the 5th Paris International Conference. Ann. Intensive Care. 2017; 7:49 DOI 10.1186/s13613-017-0260-y.


3. Vilay A.M., Wong C.S., Schrader R.M., et al. Indicators for serious kidney complications associated with toxic exposures: an analysis of the National Poison Data System. Clin Toxicol (Phila). 2013; 5: 96-105.


4. Petejovaa N., Martineka A., Zadrazilc J., Teplana V. Acute toxic kidney injury. Renal Failure 2019; 41(1): 576-594 https://doi.org/10.1080/0886022X.2019.1628780.


5. Brent J., Burkhart K., Dargan P. et al. Critical Care Toxicology. Springer International Publishing AG 2017. DOI https://doi.org/10.1007/978-3-319-17900-1.


6. Ronco C., Haapio M., House A.A., et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008; 52(19): 1527-39. doi: 10.1016/j.jacc.2008.07.051. PMID: 19007588.


7. Fadhlillah F., Patil S. Pharmacological and mechanical management of calcium channel blocker toxicity. BMJ Case Rep. 2018; 2018. doi: 10.1136/bcr-2018-225324. PMID: 30150339; PMCID: PMC6119390.


8. Jamme M., Mesnard L. Insuffisance rénale aiguë par nécrose tubulaire aiguë. Rev Prat. 2018; 68(2): 156-159. PMID: 30801141. (in French)


9. Hanif M.O., Bali A., Ramphul K. Acute Renal Tubular Necrosis. 2020 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. PMID: 29939592.


10. Saleem M., Iftikhar H.A. Rare case of acetaminophen toxicity leading to severe kidney injury. Cureus. 2019; 11(6): 5003. doi: 10.7759/cureus.5003. PMID: 31497434; PMCID: PMC6713258.


11. Lucas G.N.C., Leitão A.C.C., Alencar R.L. et al. Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs. J Bras Nefrol. 2019; 41(1): 124-130. doi: 10.1590/2175-8239-JBN-2018-0107. Epub 2018 Sep 21. PMID: 30281062; PMCID: PMC6534025.


12. Hovda K.E., Guo C., Austin R., McMartin K.E. Renal toxicity of ethylene glycol results from internalization of calcium oxalate crystals by proximal tubule cells. Toxicol Lett. 2010; 192(3): 365-72. doi:10.1016/j.toxlet.2009.11.013. Epub 2009 Nov 18. PMID: 19931368.


13. Bogomolov A.N., Oleckii V.E., Grigorev I.M. i dr. Ostrie otravleniya syrrogatami alkogolya: metanolom, etilenglikolem. Medicinskii jyrnal. 2019; 3 (69): 43-49.


14. Chang S.T, Wang Y.T, Hou Y.C. et al. Acute kidney injury and the risk of mortality in patients with methanol intoxication. BMC Nephrol. 2019; 20(1): 205. doi: 10.1186/s12882-019-1404-0. PMID: 31170938; PMCID: PMC6554873.


15. Bardakov S.N., Belskih A.N., Rijman N.N. i dr. Mangnitno-rezonansnaya tomografiya mishc v diagnostike postnagryzochnogo rabdomioliza. Lychevaya diagnostika i terapiya. 2019; 2 (10): 91-101.


16. Deighan C.J., Wong K.M., McLaughlin K.J., Harden P. Rhabdomyolysis and acute renal failure resulting from alcohol and drug abuse. QJM. 2000; 93(1): 29-33. doi: 10.1093/qjmed/93.1.29. PMID: 10623779.


17. Vale A. Rhabdomyolysis. Medicine. 2007; 35(10): 554-555. doi: 10.1016/j.mpmed. 2007.07.011.


18. Shilov V.V., Kalmanson M.L., Mihalchyk M.A. Ostrie otravleniya veshestvami prijigaushego deistviya. SPb.: Izdatelstvo SPbMAPO; 2008. - 120 s.