CASE HISTORY – January 2022

Renal impairment caused by orellanine poisoning: case reports and a literature review

Authors: Annika Adoberg, Asta Auerbach, Kadri Telling, Vladislav Mihnovitš, Ivan Pertsev, Ülo Kivistik, Joosep Seppet, Živile Riispere, Külli Kõlvald

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Seven cases of mushroom poisoning were diagnosed in Estonia in August 2020. All patients had acute kidney injury that was caused by orellanine – a nephrotoxic agent found in the Cortinarius species. Orellanine leads to latent kidney failure and the first symptoms may occur up to three weeks after consumption of the toxin.
All seven patients required hospitalization, six of them needed haemodialysis due to metabolic acidosis, hyperkalemia and uremia. Ten months after the injury three patients still needed haemodialysis and three patients had chronic kidney disease grade 4.
In the case of acute renal failure, orellanine poisoning should be considered if mushrooms have been consumed in the previous three weeks. Treatment of poisoning is symptom based.