Four family cases of acute renal failure: answer

1. In this report, four family members developed AKI within a few days following gastroenteritis. Their renal biopsies showed acute tubulointerstitial nephritis (TIN). A toxic aetiology was therefore suspected [1]. There was no history of nephrotoxic drug exposure. However, all patients ate wild mushrooms during the previous 2 weeks. Taken together, histological findings and analysis of symptoms supported the hypothesis of an orellanus syndrome secondary to ingestion of poisonous mushrooms from the Cortinarius genus [2]. 2. In cases of mushroom poisoning, the mycological identification is often uncertain and is not sufficient to confirm which mushroom was responsible for the toxicity. Therefore, identification of Cortinarius poisoning is classically performed by detecting the fungal toxin called orellanine in the biological fluids or in renal tissues [3, 4]. The toxin has been detected by high-performance liquid chromatography in renal biopsy samples [4, 5]. However, this analytical method is not generally available in clinical practice. In this report, the diagnosis of orellanus syndrome was confirmed 3 weeks after intoxication by the presence of fungal spores of Cortinarius orellanoides identified by light microscopy in the leftover contaminated meals (Fig. 1). 3. Currently, no specific treatment and no antidote is available for Cortinarius poisoning. The efficacy of corticosteroids and antioxidants (vitamin C, Nacetylcysteine) is not established [2]. Moreover, This article refers to the article that can be found at http://dx.doi.org/ 10.1007/s00467-010-1545-7. D. Talmud : J. Motte :M. Abely :C. Pietrement Pediatric Department, American Memorial Hospital, CHU de Reims, 47-51 rue Cognacq Jay, 51092 Reims, France