Clinical analysis of occupational acute toxic nephropathy by dimethyl oxalate / 中国职业医学

OBJECTIVE: To investigate the clinical features and treatment methods of occupational acute dimethyl oxalate(DMO) toxic nephropathy. METHODS: Occupational history,clinical manifestation,laboratory examination and therapy of one occupational DMO poisoning case were retrospectively analyzed. RESULTS: The patient was exposed to a large amount of DMO in a short time,with the main symptoms of dizziness,fatigue,nausea,vomiting,bloating,and oliguria.Glomerular filtration reduced after 48 hours of disease onset,serum urea nitrogen was 21. 9 mmol/L and serum creatinine was 788 μmol/L. Renal biopsy showed glomerular mesangial proliferative lesions,tubulointerstitial lesions,small arterial intima thickening and hyaline degeneration. Early treatment,including hemodialysis,hemoperfusion,hormone shock therapy,protection of myocardium,renal function,and improvement of circulation achieved a good clinical prognosis.CONCLUSION: The main clinical manifestation of acute DMO poisoning is acute kidney injury. Blood purification treatment and hormone shock therapy should be used early.

Toxic nephropathies of anticholinesterase compounds.

Nephrotoxicity is not generally recognized as a major clinical feature of anticholinesterase (AntiChE) compound poisoning. While very few case reports and experimental data are available on the topic, clinical reports suggest that the nephrotoxic effects of antiChE agents may be more common than is commonly believed. The effect of antiChE agents on the human kidney has not been carefully or thoroughly evaluated. Limited experimental data indicate that acetylcholine (ACh) which accumulates in the presence of antiChE agents, as well as antiChE agents themselves, can significantly alter renal function. This may result from alterations in neural, humoral, and metabolic activity. Some experimental data also indicate that antiChE agents may have direct nephrotoxic effects on renal tubules. This article aims to highlight antiChE agents as potential nephrotoxins. Further work is needed to explore the potential nephrotoxicity of antiChE agents in humans. Patients need to be more closely and carefully evaluated for evidence of nephrotoxic injury.