JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Global Review of Nephrotoxic Mushroom Poisonings
James Diaz, MD, DrPH
Since mushroom poisonings are increasing worldwide following ingestions of known, newly described, and even formerly edible toxic species, the objectives of this reviewwere to identify all knownnephrotoxicmushroomspecies, topresent a toxidromic approach to earlier diagnoses based on the onset of renal failure, and to compare the efficacies and outcomes of renal replacement management strategies. Internet search engines were queried with the key words in order to identify peer-reviewed scientific articles on nephrotoxic mushroom poisonings and their treatments during the searchperiod, 1957-present. Although thehepatotoxic amatoxin-containingmushrooms cause mostmushroompoisonings and fatalities, nephrotoxicmushrooms, most commonly Cortinarius species, can cause renal insufficiency and kidney failure. Recently, several new species of nephrotoxic mushrooms have been identified including Amanita proxima and Tricholoma equestre in Europe and Amanita smithiana in theUS andCanada. Renal replacement therapies including temporary hemodialysis are often indicated in the management of nephrotoxic mushroom poisonings with renal transplantation reserved for extracorporeal treatment failures. Unlike theoutcomes of amatoxicmushroompoisonings, whichareoften fatal without liver transplantation, nephrotoxicmushroom poisonings that are diagnosed early and managed with temporary renal replacement therapies have uniformly good outcomes with full recovery of pre-existing renal function unless irreversible renal failure ensues.
INTRODUCTION
METHODS
Mushroom poisonings are increasing worldwide today as young adults mistake poisonous mushrooms for hallucinogenic ones and immigrants mistake poisonous mushrooms for edible ones in their native countries. 1 There are no specific antidotes for mushroom poisonings. Treatment is supportive and aimed at halting target organ damage to the liver and kidneys. Liver or kidney transplantation may be indicated when supportive measures fail. Although retrospective, descriptive epidemiological analyses have confirmed that most mushroom poisonings are caused by unknown mushrooms, most fatal mushroom poisonings are caused by amatoxin-containing hepatotoxic mushrooms, such as Amanita phalloides and A. virosa . 2 In addition to hepatotoxic mushrooms, mushroom poisonings are also caused by nephrotoxic mushrooms, most commonly by Cortinarius mushrooms. Recently, several new species of nephrotoxic mushrooms have been described including Amanita proxima and the formerly considered edible, Tricholoma equestre , in Europe; Amanita smithiana in Canada and the US; Amanita pseudoporphyria in Japan, and the formerly considered edible, Amanita punctata in Korea. 3-8 Since mushroom poisonings are increasing worldwide following ingestions of known, newly described, and even formerly edible toxic species, the objectives of this review were to identify all known nephrotoxic mushroom species, to present a toxidromic approach to earlier diagnoses based on onset time of early versus delayed acute renal failure, and to compare the efficacies and outcomes of renal replacement management strategies.
To meet the objectives of this review, Internet search engines including PubMed, Medline, Ovid, Google®, Google Scholar® and Cochrane were queried with the key words as medical subject headings in order to identify peer-reviewed scientific articles on nephrotoxic mushroom poisonings and their treatments during the search period, 1957-present. The key words included mushrooms, poisonous, nephrotoxic; Amanita, poisonous, nephrotoxic; Cortinarius , poisonous, nephrotoxic; orellanus syndrome, and orellanine. The articles selected to meet the first objective to identify all nephrotoxic mushroom species included case reports and case series of nephrotoxic mushroom poisonings. The articles selected to meet the second and third objectives to present a toxidromic approach to earlier diagnoses and to compare the efficacies and outcomes of renal replacement treatment strategies included observational studies, retrospective descriptive epidemiological studies, and toxicological investigations. Since this investigation was a review of prior published scientific articles, Institutional Review Board approval was not required.
RESULTS
The Epidemiology of Mushroom Poisoning in the United States
Although there are no formal national registries for mushroom poisoning, the American Association of Poison Control Centers (AAPCC) has operated a surveillance system, the Toxic
162 J La State Med Soc VOL 169 NOVEMBER/DECEMBER 2017
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