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.

Five cases of acute kidney injury caused by occupational acute dimethyl oxalate poisoning / 中国职业医学

OBJECTIVE: To investigate the clinical features and treatment methods of acute kidney injury induced by occupational acute dimethyl oxalate( DMO) poisoning.METHODS: Retrospective analysis was performed on the clinical data of 5 patients with acute kidney injury induced by occupational DMO poisoning.RESULTS: A large number of crystals of DMO were found in the workplace in field investigation.Five patients had acute onset.The main manifestations included dizziness,fatigue,nausea,vomiting,anorexia,lumbar and abdominal pain,skin burning sensation,oliguria,peeling changes on the skin of neck,the front chest and perineum,and low calcium,anemia,and pulmonary infection.The laboratory examinations suggested acute kidney injury,creatinine at the onset was 159-421 μmol/L.The highest creatinine level was up to 848μmol/L in the course.The renal pathology of a case suggested acute tubular injury with tubular deposition of oxalate crystals in the lumen.After blood purification( treated with hemodialysis mainly,combined with continuous hemofihration and hemoperfusion intermittently) combined with anti-oxidative stress,liver protection,nutritional support and other symptomatic treatment,renal function of the 4 cases with oliguria returned to normal.CONCLUSION: Occupational acute DMO poisoning mainly leads to kidney injury.The treatment is mainly based on hemodialysis and anti-oxidative stress.The prognosis of patients is good.