Four family cases of acute renal failure: answer

Cortinarius poisoning is a rare syndrome that is responsible for a delayed toxic tubulointerstitial nephritis that can induce severe acute or chronic renal failure in children and adults [2]. Cortinarius mushrooms are ubiquitous all over Europe, where they grow in mountain forests and woody areas. Not all mushrooms of the Cortinarius genus are toxic, but three species, specifically C. speciosissimus, C. orellanus and C. orellanoides are known to cause poisoning [2]. Our four family patients demonstrated a typical orellanus syndrome characterised by a prerenal phase, with nonspecific digestive disorders occurring within 3 days (12 h to 14 days) after ingestion of the mushrooms. Moreover, a flu-like syndrome was observed in one of our patients [6]. Liver injury has also been described [7] but was not observed in our patients. Sometimes, because of the large duration of the asymptomatic phase, mushroom consumption is repeated in several meals, as in patients in this family. The renal phase was delayed (4–15 days, with a median of 8.5 days after the first mushroom meal). AKI due to tubulointerstitial injury occurs 30–70% of patients according to the previous published series [7, 8]. In our report, all individuals presented with AKI, with variable degrees of severity. When the renal function is normal, a latent TIN may not be suspected in the absence of microscopic hematuria and leukocyturia. The tubular epithelium is the toxin’s target, with a direct dose-dependent toxicity that explains the severity of tubulointerstitial injury in the case of the child in our report [7]. The prognosis of Cortinarius poisoning is poor, and about 50% of patients present with acute renal failure that evolves into chronic renal failure [2]. In children, a very poor outcome had been described in previous published cases, indicating that all of the five reported cases rapidly developed acute renal failure requiring renal replacement therapy and kidney transplantation in one of them [9, 10].