Clinical Experimental Study On Poisoning Of Amanita Neoovoidea

Objectives:1.Study the clinical features and prognosis of acute kidney injury caused by mushroom poisoning;2.Study the mechanism of acute kidney injury caused by Amanita neoovoidea.Methods:1.The clinical characteristics of 44 patients with acute kidney injury caused by mushroom poisoning admitted to Chuxiong prefecture People’s Hospital from January 2013 to December 2021 were retrospectively analyzed.According to clinical manifestations,it is divided into prerenal renal injury（type I）,primary renal injury（type II）and secondary renal injury（type III）,of which primary renal injury includes two categories:liver injury with renal injury（type IIA）and renal injury mainly（type IIB）.2.Taking Kunming mice as the research object,the modified Kou’s method was used to calculate the LD₅₀of Kunming mice by intraperitoneal injection of Amanita neoovoidea;The changes of alanine aminotransferase（ALT）,aspartate transferase（AST）,urea nitrogen（BUN）and serum creatinine（Scr）in mice were measured on the3rd and 7th day after intraperitoneal injection and oral gavage of 10g/kg.bw Amanita neoovoidea and the pathological examination of liver and kidney was performed.Results:（1）A total of 44 cases of acute kidney injury caused by mushroom poisoning were collected,including 18 cases（40.9%）of type I,23 cases（52.3%）of type II,including 19 cases of type IIA（43.2%）and 4 cases of type IIB（9.1%）,3 cases of type III（6.8%）.Type I patients were mainly manifested as acute gastroenteritis,the incubation period was（9.28±1.8）h,the time from eating mushrooms to admission was（1.8±0.4）d,the average hospitalization was（5.2±0.5）d,and the admission ALT was（42.3±27.0）U/L,AST（44.3±31.7）U/L,BUN（19.0±4.4）mmol/L,Scr（192.8±93.4）umol/L;type IIA patients had mild gastroenteritis symptoms,but severe liver damage,and the incubation period was（13.47±0.89）h,the time from eating mushrooms to admission was（2.5±0.3）d,the average hospitalization days（8.3±3.0）d,admission ALT（2226.8±2213.3）U/L,AST（1915.2±2213.4）U/L,BUN（11.01±3.4）mmol/L,Scr（232.5±151）umol/L;type IIB patients had mild gastroenteritis reaction,kidney injury was the main incubation period（19.5±4.5）h,and the time from eating mushrooms to admission was（4±1.3）d,average hospitalization（12.5±0.65）d,admission ALT（181.8±199.7）U/L,AST（47.8±57.7）U/L,BUN（31.2±8.0）mmol/L,Scr（1377.0±339.4）umol/L;type III patients showed rhabdomyolysis with acute kidney injury,the incubation period was（2.3±0.3）h,the time from eating mushrooms to admission was（2±0）d,the average hospitalization was（39.67±1.76）d,and the admission ALT was（1161.3±36.3）U/L,AST（2648.7±402.0）U/L,BUN（12.0±4.9）mmol/L,Scr（158.1±59.0）umol/L,CK（39596±21059）U/L,CK-MB（2254.4±740.9）U/L.（2）The LD₅₀of Amanita neoovoidea on Kunming mice is 19.98g/kg.bw（relative to dry powder weight）,and the 95%confidence limit is 12.03-33.16g/kg.bw.pathological manifestations of poisoned mice:no liver damage,focal hemorrhage in the renal cortex and medulla junction and medulla area,swelling of renal tubular epithelial cells,partial epithelial cells shedding,no obvious cast,interrenal no obvious inflammatory cell infiltration was found.There was no significant difference in ALT,AST,BUN,Scr between intraperitoneal injection and oral gavage of 10g/kg.bw Amanita neoovoidea and the control group on the 3rd and7th day,and there was no obvious abnormality in pathological changes.Conclusions:（1）Prerenal renal injury is mainly gastrointestinal symptoms,and the prognosis is good;the mortality of patients with liver injury and renal injury injury is high and the prognosis is poor;the prognosis of patients with renal injury is better;Secondary renal injury due to rhabdomyolysis has a poor prognosis and high mortality.（2）Intraperitoneal injection of large-dose Amanita neoovoidea can induce acute kidney injury in Kunming mice,Renal pathological changes are mainly acute tubular necrosis.