A Case of Chronic Ethylene Glycol Intoxication Presenting without Classic Metabolic Derangements

Acute ethylene glycol ingestion classically presents with high anion gap acidosis, elevated osmolar gap, altered mental status, and acute renal failure. However, chronic ingestion of ethylene glycol is a challenging diagnosis that can present as acute kidney injury with subtle physical findings and without the classic metabolic derangements. We present a case of chronic ethylene glycol ingestion in a patient who presented with acute kidney injury and repeated denials of an exposure history. Kidney biopsy was critical to the elucidation of the cause of his worsening renal function.

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Ethylene Glycol Intoxication Requiring ECMO Support

Case Reports in Critical Care ◽

10.1155/2021/5545351 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Raphael Rosen ◽

Shelief Robbins-Juarez ◽

Jacob Stevens

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Metabolic Acidosis ◽

Ethylene Glycol ◽

Extracorporeal Membrane Oxygenation ◽

Kidney Injury ◽

Neurological Injury ◽

Severe Metabolic Acidosis ◽

Toxic Metabolites ◽

Ethylene Glycol Intoxication

Ethylene glycol is commonly used in antifreeze, and ingestion of even a small amount can result in acute kidney injury, severe metabolic acidosis, and neurological injury. When cases are recognized early, treatment involves administration of alcohol dehydrogenase inhibitors to prevent conversion to toxic metabolites of glycolate, glyoxolate, and oxalate. In later presentations with more severe renal injury, hemodialysis may be required for clearance of toxic metabolites and supportive care for renal failure. We present the first reported case of severe ethylene glycol intoxication requiring support of extracorporeal membrane oxygenation (ECMO) due to refractory cardiopulmonary collapse.

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Successful Resuscitation of a Patient with Life-Threatening Metabolic Acidosis by Hemodialysis: A Case of Ethylene Glycol Intoxication

Case Reports in Nephrology ◽

10.1155/2017/9529028 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Ikuyo Narita ◽

Michiko Shimada ◽

Norio Nakamura ◽

Reiichi Murakami ◽

Takeshi Fujita ◽

...

Keyword(s):

Acute Kidney Injury ◽

Metabolic Acidosis ◽

Ethylene Glycol ◽

Kidney Injury ◽

University Hospital ◽

Severe Metabolic Acidosis ◽

Continuous Hemodiafiltration ◽

Successful Resuscitation ◽

Life Threatening ◽

Ethylene Glycol Intoxication

Background. Ethylene glycol intoxication causes severe metabolic acidosis and acute kidney injury. Fomepizole has become available as its antidote. Nevertheless, a prompt diagnosis is not easy because patients are often unconscious. Here we present a case of ethylene glycol intoxication who successfully recovered with prompt hemodialysis. Case Presentation. A 52-year-old Japanese male was admitted to a local hospital due to suspected food poisoning. The patient presented with nausea and vomiting, but his condition rapidly deteriorated, with worsening conscious level, respiratory distress requiring mechanical ventilation, hypotension, and severe acute kidney injury. He was transferred to the university hospital; hemodialysis was initiated because of hyperkalemia and severe metabolic acidosis. On recovering consciousness, he admitted having ingested antifreeze solution. Thirty-seven days after admission, the patient was discharged without requiring HD. Conclusions. We reported a case of ethylene glycol intoxication who presented with a life-threatening metabolic acidosis. In a state of severe circulatory shock requiring catecholamines, hemodialysis should be avoided, and continuous hemodiafiltration may be a preferred approach. However, one should be aware of the possibility of intoxication by unknown causes, and hemodialysis could be life-saving with its superior ability to remove toxic materials in such cases.

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Ethylene glycol intoxication presenting with high anion gap metabolic acidosis, acute kidney injury and elevated lactate

Pediatrics International ◽

10.1111/ped.13477 ◽

2018 ◽

Vol 60 (2) ◽

pp. 194-195 ◽

Cited By ~ 4

Author(s):

Thomas Giner ◽

Violeta Ojinaga ◽

Nikolaus Neu ◽

Miriam Koessler ◽

Gerard Cortina

Keyword(s):

Acute Kidney Injury ◽

Metabolic Acidosis ◽

Ethylene Glycol ◽

Kidney Injury ◽

Anion Gap ◽

Ethylene Glycol Intoxication ◽

Elevated Lactate

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Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

BMC Nephrology ◽

10.1186/s12882-020-02213-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Katarzyna Szajek ◽

Marie-Elisabeth Kajdi ◽

Valerie A. Luyckx ◽

Thomas Hans Fehr ◽

Ariana Gaspert ◽

...

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Kidney Biopsy ◽

Kidney Diseases ◽

Case Reports ◽

Kidney Injury ◽

Maculopapular Rash ◽

Tubular Injury ◽

Granulomatous Interstitial Nephritis ◽

First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

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Immunotherapy‐related acute kidney injury: Kidney biopsy or not?

Nephrology ◽

10.1111/nep.13687 ◽

2020 ◽

Vol 26 (1) ◽

pp. 89-90 ◽

Cited By ~ 1

Author(s):

Sophie Chatterton ◽

Sarah Williams ◽

Kazi Nahar ◽

Alexander M. Menzies ◽

Muh G. Wong

Keyword(s):

Acute Kidney Injury ◽

Kidney Biopsy ◽

Kidney Injury

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Diagnostic utility of kidney biopsy in patients with sarcoidosis and acute kidney injury

International Journal of Nephrology and Renovascular Disease ◽

10.2147/ijnrd.s22549 ◽

2011 ◽

pp. 131 ◽

Cited By ~ 8

Author(s):

Ravish Shah ◽

Ravish Shah

Keyword(s):

Acute Kidney Injury ◽

Kidney Biopsy ◽

Kidney Injury ◽

Diagnostic Utility

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Tubulitis in a patient treated with nivolumab: Case report and literature review

Journal of Onco-Nephrology ◽

10.1177/2399369318812969 ◽

2018 ◽

Vol 2 (2-3) ◽

pp. 107-112

Author(s):

Viral Vakil ◽

Mark Birkenbach ◽

Katti Woerner ◽

Lihong Bu

Keyword(s):

Acute Kidney Injury ◽

Immune Checkpoint Inhibitors ◽

Kidney Biopsy ◽

Tubulointerstitial Nephritis ◽

Checkpoint Inhibitors ◽

Kidney Injury ◽

Programmed Death Ligand 1 ◽

Programmed Death ◽

Metastatic Urothelial Carcinoma ◽

Programmed Death 1

Kidney injury associated with use of immune checkpoint inhibitors that target the programmed death-1 molecule commonly manifests as acute tubulointerstitial nephritis on kidney biopsy. We present a case of a 66-year-old man who developed acute kidney injury at 6 months after initiation of treatment with anti-programmed death-1 antibody, nivolumab, for treatment of metastatic urothelial carcinoma. A renal biopsy showed focal moderate-to-severe lymphocytic tubulitis with minimal interstitial inflammation. Programmed death ligand-1 immunopositivity was detected only in tubules exhibiting lymphocytic tubulitis. The patient’s renal function improved to baseline with conservative management consisting of discontinuation of nivolumab followed by prednisone treatment.

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Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings

Case Reports in Nephrology and Dialysis ◽

10.1159/000507426 ◽

2020 ◽

Vol 10 (1) ◽

pp. 42-50 ◽

Cited By ~ 2

Author(s):

Yuko Oyama ◽

Yoichi Iwafuchi ◽

Tetsuo Morioka ◽

Ichiei Narita

Keyword(s):

Elderly Patient ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Biopsy ◽

Fluid Management ◽

Kidney Injury ◽

Oral Prednisolone ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Fluid Removal

Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.

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