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TRANSHEPATIC PLACEMENT OF HAEMODIALYSIS CATHETER: A SOLUTION FOR VASCULAR ACCESS EXHAUSTION
Author(s) -
Yap Desmond Yat Hin,
Tso Wai Kuen,
Chu Ferdinand Siu Kay,
Chan Tak Mao,
Lai Kar Neng,
Tang Sydney Chi Wai
Publication year - 2010
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2010.01279.x
Subject(s) - queen (butterfly) , medicine , university hospital , family medicine , hymenoptera , botany , biology
10–20%. Kidney injury following intoxication with Amanita manifests as acute tubular necrosis. It usually resolves after resolution of liver injury and in exceptional cases may lead to ESKF. There are no experimental models of Amanita-induced acute kidney injury to address its pathophysiology. Contributory factors to renal injury may be pre-existing kidney disease, hypovolaemia and nephrotoxic drugs. No pre-existent kidney disease was identified in our patient and, except for a tacrolimus, she was not receiving other nephrotoxic drugs. However, it is unlikely that only exposure to tacrolimus, although it may be contributory, was predominantly responsible for development and maintenance of prolonged oliguric acute kidney injury with eventual chronic end-stage kidney disease. Similarly, hepatorenal syndrome should have resolved with successful liver transplantation. With a pathohistological finding of only mild acute tubular injury and mild chronic changes, recovery of renal function should be expected. We speculate that Amatoxin alone or in the combination with medications was responsible for irreversible kidney damage. A successful liver transplantation may have unmasked potential of Amanita intoxication to lead to CKD.