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A 43-year-old previously healthy man presented with a 10-day history of feeling unwell, nausea, vomiting, diarrhoea, myalgia and fever. He had not passed urine for 2 days. He was not taking any medications and denied taking recreational or ‘over the counter’ drugs.On examination, he was dehydrated. Blood pressure was 150/90 mmHg. Systemic examination was otherwise normal. Initial blood/serum tests were as follows: creatinine 2650 μmol/l, urea 50 mmol/l, potassium 6.7 mmol/l, sodium 128 mmol/l, C-reactive protein 30 mg/l, normal liver function tests and haemoglobin 14.4 g/dl. Urine microscopy revealed haematuria and leukocyturia but no proteinuria or casts. Chest X-ray showed congested lung fields. Renal ultrasound showed echogenic but normal sized kidneys with no evidence of obstruction. Anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, extractable nuclear antibodies, anti-glomerular basement membrane antibodies and myeloma screen were negative. Kidney biopsy performed 3 days after admission showed normal glomeruli, severe interstitial nephritis with a predominantly lymphocytic infiltrate and moderate degree of tubular necrosis. Staining for immunoglobulins and complement was negative. Electron microscopy showed no glomerular deposits.The patient was commenced on haemodialysis from the day of admission. As the aetiology of this patient’s acute kidney injury (AKI) was still unknown, history was revisited. He accepted eating raw wild mushrooms whilst on a backpacking trip in the mountains of north Wales in the UK, …

Successful living related kidney transplantation for end-stage renal failure caused by orellanine syndrome