Long-term clinical outcome for patients poisoned by the fungal nephrotoxin orellanine

Heidi Hedman, Johan Holmdahl, Johan Mölne, Kerstin Ebefors, Börje Haraldsson, Jenny Nyström, Heidi Hedman, Johan Holmdahl, Johan Mölne, Kerstin Ebefors, Börje Haraldsson, Jenny Nyström

Abstract

Background: Accidental intake of mushrooms of the Cortinarius species (deadly webcap) may cause irreversible renal damage and the need for dialysis or transplantation. The species is found in forests of Northern Europe, Scandinavia and North America and may be mistaken for other edible mushrooms. The highly selective nephrotoxic compound of the mushroom is called orellanine. Very little is known about the long-term effects of the nephrotoxin.

Methods: We identified patients who ingested deadly webcap in the period of 1979 to 2012. Informed consent and medical records were obtained for 28 of the 39 cases that occurred during the 34-year period. A case control group was also studied based on sex, age and initiation of dialysis or transplantation.

Results: The average age at time of the accidental intake was 40 ± 3 (n = 28) years. 64% of patients were male, and 22 of 28 patients developed acute kidney injury requiring dialysis. Serum creatinine peaked at 1 329 ± 133 μmol/l, and serum urea was 31 ± 3.5 mmol/l. No signs of acute damage were present in any other organ. The average time of follow-up was 16.9 ± 2.1 years (1.24-34.3 years, n = 28). 15 patients were transplanted and 3 also had a second graft. At follow-up, 23 patients were alive, and five had died at ages of 67 ± 5 (range 54-84). The outcome was similar in the case control group with 6 deaths in 20 patients.

Conclusion: We conclude that the long-term prognosis for patients poisoned by deadly webcap who lost their renal function is not different compared to other patients in active uremic care.

Figures

Fig. 1
Fig. 1
Specimens of the deadly webcap or Cortinarius rubellus (synonymous with Cortinarius speciosissimus), younger and older mushrooms with slightly different appearance. Picture by Hans Marklund
Fig. 2
Fig. 2
Light microscopy from a Cortinarius intoxicated patient showing proximal tubular damage (arrows) in some tubules. There are focal apoptotic bodies (arrowheads), denudation and tubular dilatation (★). Haematoxylin-eosin stain
Fig. 3
Fig. 3
Kaplan Mayer survival curve over the two groups. No statistical differences were seen between the study group (intoxicated patients) and the control group over time

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