Abstract: PUB025
Toxic Attack: Organophosphate-Induced Acute Tubular Necrosis
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kalfayan, Garo, Los Robles Regional Medical Center, Thousand Oaks, California, United States
- Gower, Arian, Los Robles Regional Medical Center, Thousand Oaks, California, United States
- Takher, Jasprit, Los Robles Regional Medical Center, Thousand Oaks, California, United States
Introduction
Although organophosphate (OP) induced renal injury has been documented sporadically, there has not been an identified pathophysiology. The biopsy proven acute tubular necrosis due to organophosphate poisoning is unique as it may provide information into the pathophysiology of the disease process.
Case Description
A 73-year-old male presented to the emergency department after ingesting approximately 240 ml of a glyphosate-based herbicide as a suicide attempt. He was found to have elevated creatinine of 3.9 mg/dL and BUN of 40 mg/dL. Urine studies revealed urine sodium of 38 mmol/L and urine creatinine of 101 mg/dL, FENa of 1.1%, consistent with intrinsic etiology. Conservative management with lactated ringers 100 ml/hr was started initially. The patient’s creatinine continued to trend upwards to 5.60 mg/dL, and a renal biopsy was performed. Due to worsening renal failure, the patient was placed on hemodialysis. The patient subsequently developed acute respiratory failure secondary to aspiration and required intubation. As his condition deteriorated the patient’s family elected for hospice care, and patient later expired. Biopsy was found to report acute tubular necrosis due to toxic exposure to organophosphate.
Discussion
Organophosphate poisoning occurs in nearly three million people worldwide per year with symptoms involving the autonomic nervous system, neuromuscular junction, and central nervous system. Sporadically OP poisoning can cause AKI, with patients potentially developing ATN. This case illustrates organophosphates ability to perhaps cause direct damage to renal tubules. The biopsy results demonstrated acute injury and necrosis of the proximal tubules with focally prominent cytoplasmic swelling and near circumferential shedding of necrotic epithelial cells. This case illustrates OP ability to cause direct injury as the pathophysiology behind the disease process.
Acute Tubular Necrosis