JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
In the late 1990s, cases of renal insufficiency and failure were initially reported from Oregon and British Columbia following the consumption cooked Amanita smithiana mushrooms mistaken for edible pine or matsutake mushrooms, Tricholoma magnivelare . 5,6 In 1997, Leathem and coinvestigators in British Columbia reported four cases of renal failure in patients who had consumed cooked Amanita smithiana mushrooms and developed gastrointestinal symptoms five to eight hours following ingestion (Figure 3). 5 One of the patients, an elderly diabetic, presented to an emergency department with renal failure the day after a mushroom meal and required hemodialysis. 5 The remaining three patients presented to local emergency departments five to six days after mushroom ingestions and also received supportive care with hemodialysis. 5 All patients subsequently regained normal renal function. 5 In 1998,Warden and Benjamin in Portland, Oregon, reported four additional cases of acute renal failure following the consumption of cooked Amanita smithiana mushrooms in patients mistaking A. smithiana for matsutake mushrooms (Figure 3). 6 All patients presented with gastrointestinal symptoms from 20 minutes to 12 hours following mushroom consumption. 6 All patients subsequently developed acute renal failure four to six days
Figure 1: Cortinarius speciosissimus (synonym C. rubellus) , also known as the deadly webcap, is one of eight or more nephrotoxic species of Cortinarius mushrooms with large flat orange to rusty brown caps with gills connected to thick stems without rings. The top of the cap may have a darker umbo or protuberance. The mushroom has a slight radish smell and has been mistaken for edible chanterelle mushrooms. Source: Wikimedia commons (public domain). Photographer: Eric Steinert.
following ingestion of Cortinarius species mushrooms, most of which can be found in the US, including Louisiana. 22
By 1997, several other Cortinarius species were laboratory- confirmed to contain orellanine including C. henrici, C. orellanoides, and C. ranierensis in the US and Canada. 21 Other Cortinarius species were also suspected of containing orellanine. As a result, all Cortinarius mushrooms are now considered potentially nephrotoxic, and none are recommended for consumption in any form: raw, boiled, cooked, dried, or frozen. 21 The mechanisms of orellanine’s toxicity are unknown, but may be the result of an unidentified nephrotoxic metabolite. 23 Oubrahimand coinvestigators have demonstrated that oxidated orellanine can generate orthosemiquinone anion radicals in vitro that produce oxygen free radicals and deplete glutathione. 23, 24 The investigators have postulated that the oxidation of orellanine in the kidneys may result in an accumulation of quinone metabolites that covalently bind to renal tissues and cause cellular damage. 23, 24 In 1994, Leray and coinvestigators in Montpellier, France, were the first to report five cases of acute renal insufficiency following consumption of cooked Amanita proxima mushrooms that were most likely mistaken for the edible Amanita species, Amanita ovoidae , that shares the same habitat (Figure 2). 25 Temporary hemodialysis was required in four of the five cases, and all patients recovered quickly with normal renal and hepatic function restored by three weeks. 25 The authors also described early gastrointestinal symptoms followed by rising laboratory biomarkers of cytolytic hepatitis in all cases similar to the early manifestations of hepatotoxic amanitin-containing mushroom poisonings. 25
Figure 2: Amanita proxima is one of seven or more nephrotoxic Ama- nita species of mushrooms and has most often been confused with an edible Amanita mushroom, A. ovoidae. A. proxima has a large white cap that flattens out with age with free gills unattached to thick stems with membranous rings. Most poisonings have been reported from France and have caused acute renal failure requiring temporary hemodialysis within a few days of ingestion with good outcomes. Source: Wikimedia commons (public domain). Photographer: James Baker.
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