Autori: Carlo Giammarresi, Luisa Bono, Gioacchino Li Cavoli, Barbara Oliva, Camillo Carollo, Rosanna Turdo, Antonio Amato, Vitalba Azzolina, Rosy Mongiovì, Franca Servillo, Onofrio Schillaci, Carmela Zagarrigo, Angelo Tralongo, Flavia Caputo.
Affiliazioni: UOC Nefrologia Dialisi Trapianto Renale, ARNAS Civico e Di Cristina, Palermo
AKI can be consequence of eating mushrooms mostly after ingestion of Cortinarius orellanus group but also of genus Amanita mushrooms. Amanita proxima is a well-known cause of nephrotoxic syndrome due to norleucine toxin. Edible and toxic species of genus Amanita are often confused. Amanita ovoidea is a common large, white-colored fungus; often it causes severe gastrointestinal discomfort. A. proxima is very similar to A. ovoidea. Both A. proxima and A. ovoidea are widespread in the Mediterranean area. Our experience. In October 2017 a 49-year-old male, with previous normal renal function, collected mushrooms in a small forest. He was admitted to the hospital because of nausea, vomiting, and anuria started 12 hours after eating of wild mushrooms; 4 of his relatives ate the same meal but they remained asymptomatic. Renal ultrasound showed no hydronephrosis, normal size and echogenicity. Blood pressure value was 180/ 100 mmHg. Laboratory showed impaired renal function (creatinine 8 mg/dL, urea 220 mg/dL) and moderate hepatocytolysis (AST: 240, ALT: 390). No pathogens grew on culture of urine or stool. The remaining parts of the collected mushrooms (about 750 gr) were examined by an expert Mycologist who identified the species A. Ovoidea. The patient was treated with volume repletion without significant improvement in his symptoms. Therefore he underwent to haemodialysis for 10 days until the urine output increase with serum creatinine and AST/ALT reduction. Immunological tests and other microbiological investigations resulted negative. After 4 weeks we observed renal function normalization (Creatinine 1 mg/dl). The “Amanita nephrotoxic syndrome” is characterized by early onset of gastrointestinal symptoms, mild hepatic damage and severe but reversibile acute renal failure. A. ovoidea is a common fungus with little value. The edibility of A. ovoidea is dubious and there are known cases of poisoning that affected the gastrointestinal tract after eating of this species.