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肾脏病与透析肾移植杂志 ›› 2024, Vol. 33 ›› Issue (5): 424-429.DOI: 10.3969/j.issn.1006-298X.2024.05.004

• 论著 • 上一篇    下一篇

草酸二甲酯中毒相关肾损伤的临床病理特征及转归

  

  • 出版日期:2024-10-28 发布日期:2024-11-01

Clinicopathological characteristics and outcomes of nephropathy associated with dimethyl oxalate poisoning

  • Online:2024-10-28 Published:2024-11-01

摘要: 目的:分析草酸二甲酯(DMO)中毒患者的临床病理特征、治疗及结局,为临床救治提供依据。
方法:分析国家肾脏疾病临床医学研究中心3例DMO中毒相关肾损伤患者资料,复习文献并总结此类中毒患者的临床表现、病理特征、治疗和结局。
结果:3例男性患者在接触DMO后均发生严重的急性肾损伤(AKI),经肾活检病理证实为急性草酸盐肾病,接受血液净化、充分水化、抗炎等治疗后,肾功能均较前好转。文献报道的21例经皮肤直接接触或呼吸道DMO中毒患者,95.2%有不同程度血清肌酐升高,52.4%达到AKI 3期;61.9%行临时血液净化,23.8%接受糖皮质激素治疗;9.5%死于多脏器功能衰竭,71.4%肾功能恢复正常。
结论:DMO中毒以AKI和大量草酸盐沉积为特征,血液净化、充分水化、枸橼酸盐和小剂量激素可能是有效的治疗手段,大部分患者肾功能可恢复正常。


关键词: 草酸盐肾病, 急性肾损伤, 草酸二甲酯, 中毒性肾病

Abstract: Objective:Analyze the clinicopathological features, treatment strategy, and outcomes of patients suffering from DMO poisoning.
Methodology:This study presented three cases of nephropathy associated with DMO poisoning at our center. Additionally, a literature review was conducted to summarize the clinicopathological features, treatment strategies, and outcomes of acute DMO poisoning.
Results:Three male patients developed severe acute kidney injury (AKI) subsequent to DMO exposure. Renal biopsy confirmed the diagnosis of acute oxalate nephropathy. Following treatment strategies that included hemodialysis, adequate hydration, and anti-inflammatory agents, all patients exhibited improvement in renal function. A literature review of 21 reported cases of DMO poisoning, uia dermal contact or respiratory exposure, revealed that 95.2% exhibited varying degrees of elevated serum creatinine levels, and 52.4% were identified with AKI stage 3. 61.9% of the patients underwent hemodialysis, while 23.8% were treated with glucocorticoids. 9.5% of the patients succumbed to multiple organ failure, whereas 71.4% achieved normal renal function.
Conclusion:DMO poisoning is characterized by acute kidney injury, with oxalate crystals observed in renal pathological findings. Therapeutic interventions such as hemodialysis, hydration, citrate solutions, and low-dose glucocorticoids may offer clinical benefits post-intoxication. The majority of the patients experienced a recovery of kidney function.


Key words: oxalate nephropathy, acute kidney injury, dimethyl oxalate, toxic nephropathy