Paraquat-associated Severe Acute Kidney Injury—Study from India

Main Article Content

Manjusha Yadla
K. Manu
K.V. Anupama
B. Rajasekhar

Keywords

severe acute kidney injury, paraquat ingestion, poisoning, renal replacement therapy

Abstract

To analyze the outcomes of severe acute kidney injury in patients with paraquat ingestion. This retrospective analysis of case records was done in our institute, a tertiary care government teaching hospital, over a period of 4 years. Of the total 1310 acute paraquat poisonings during this period, severe acute kidney injury (AKI), referred for nephrology management was observed in 60 patients. Common symptoms at presentation include vomiting, oral ulcers, and abdominal pain. Oliguric AKI was present in 26%. Need for renal replacement therapy was observed in 95% of the cases. Mortality was observed in 38 of the 60 patients (68%). Factors associated with mortality on Cox regression analysis include amount of consumption. Estimated duration of survival on analysis curves was 8 days in 50% after admission and 15 days after consumption in 50%. Paraquat poisoning is associated with grave outcomes of morbidity and mortality. Severity of AKI is significant in this poisoning. Amount of consumption, latency of referral play a major role in outcomes.

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References

1. Dileep Kumar D. Conditions of paraquat use in India [Internet]. Available from: https://www.iuf.org/wp-content/uploads/attachments/Joint%20paraquat%20study%20India_0.pdf

2. World Health Organization [Internet]. Paraquat and diquat. EHC 39: 1984; Available at: https://apps.who.int/iris/bitstream/handle/10665/37301/9241540994-eng.pdf

3. Sandhu JS, Dhiman A, Mahajan R, Sandhu P. Outcome of paraquat poisoning. Indian J Nephrol. 2003;13:64–8.

4. Smith P, Heath D, Kay JM. The pathogenesis and structure of paraquat-induced pulmonary fibrosis in rats. J Pathol. 1974 Oct;114(2):57–67. 10.1002/path.1711140202

5. Vijeyaratnam GS, Corrin B. Experimental paraquat poisoning: A histological and electron-optical study of the changes in the lung. J Pathol. 1971;103(2):123–9. 10.1002/path.1711030207

6. Matsumori H, Matsumoto T, Ishikawa H. Acute toxic effects of paraquat on ultrastructure of rat liver. Acta Pathol Jpn. 1984;34(3):507–18. 10.1111/j.1440-1827.1984.tb07579.x

7. Gawarammana IB, Buckley NA. Medical management of paraquat ingestion. Br J Clin Pharmacol. 2011;72(5):745–57. 10.1111/j.1365-2125.2011.04026.x

8. Hsu CW, Lin JL, Lin-Tan DT, Chen KH, Yen TH, Wu MS, et al. Early hemoperfusion may improve survival of severely paraquat-poisoned patients. PLoS One. 2012;7(10):e48397. 10.1371/journal.pone.0048397

9. Ito H. Silent acute renal impairment after low-dose paraquat ingestion. Case Rep Acute Med. 2019;2(2):31–4. 10.1159/000501648

10. Safaei Asl A, Dadashzadeh P. Acute kidney injury in patients with paraquat intoxication; a case report and review of the literature. J Renal Inj Prev. 2016;5(4):203–6. 10.15171/jrip.2016.43

11. Isha IT, Alam ZN, Shaha BK, Bari MS, Bari MZJ, Chowdhury FR. Paraquat induced acute kidney injury and lung fibrosis: A case report from Bangladesh. BMC Res Notes. 2018;11:344. 10.1186/s13104-018-3425-3

12. Adejumo OA, Akinbodewa AA, Olafisoye OJ, Afolabi ON. Acute kidney injury following paraquat poisoning: An uncommon cause of acute toxic nephropathy. J Med Trop. 2016;18(1):51–3. 10.4103/2276-7096.177828

13. Weng CH, Chen HH, Hu CC, Huang WH, Hsu CW, Fu JF, et al. Predictors of acute kidney injury after paraquat intoxication. Oncotarget. 2017;8(31):51345–54. 10.18632/oncotarget.17975

14. Kim S-J, Gil H-W, Yang J-O, Lee E-Y, Hong S-Y. The clinical features of acute kidney injury in patients with acute paraquat intoxication. Nephrol Dial Transplant. 2009;24(4):1226–32. 10.1093/ndt/gfn615

15. Pavan M. Acute kidney injury following paraquat poisoning in India. Iran J Kidney Dis. 2013;7(1):64–6.

16. Van Vleet TR, Schnellmann RG. Toxic nephropathy: Environmental chemicals. Semin Nephrol. 2003;23:500–8. 10.1016/S0270-9295(03)00094-9

17. Mohamed F, Buckley NA, Jayamanne S, Pickering JW, Peake P, Palangasinghe C, et al. Kidney damage biomarkers detect acute kidney injury but only functional markers predict mortality after paraquat ingestion. Toxicol Lett. 2015;237(2):140–50. 10.1016/j.toxlet.2015.06.008

18. Mohamed F, Endre Z, Jayamanne S, Pianta T, Peake P, Palangasinghe C, et al. Mechanisms underlying early rapid increases in creatinine in paraquat poisoning. PLoS One. 2015;10(3):e0122357. 10.1371/journal.pone.0122357

19. Kim SJ, Gil HW, Yang JO, Lee EY, Hong SY. The clinical features of acute kidney injury in patients with acute paraquat intoxication. Nephrol Dial Transplant. 2009;24(4):1226–32. 10.1093/ndt/gfn615