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NDT Plus Advance Access originally published online on November 26, 2008
NDT Plus 2009 2(1):40-42; doi:10.1093/ndtplus/sfn178
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Renal cortical necrosis complicating laundry detergent ingestion

Leonardo Vidal Riella1, Sunitha Golla4, Grigore Dogaru5, Helmut G. Rennke2 and Kenneth Christopher3

1 Renal Division
2 Renal Division
3 Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
4 Department of Medicine, MetroWest Medical Center
5 Department of Nephrology, University of Medicine and Pharmacy, Targu Mures, Romania

Correspondence: Correspondence and offprint requests to: Leonardo Vidal Riella, Medical Research Building 4th floor, Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Tel: +00-1-617-732-5252; Fax: +1-617-732-6392; E-mail: lriella{at}rics.bwh.harvard.edu


  Abstract

Accidental oral detergent ingestion usually causes mild gastrointestinal manifestations including nausea, vomiting and diarrhea as well as upper airway irritation. There are a limited number of reported oral detergent ingestions leading to acute kidney injury, mainly due to rhabdomyolysis. We present an ultimately fatal case of laundry detergent ingestion leading to biopsy proven severe cortical necrosis and irreversible renal damage. Detergent ingestion was associated with widespread endothelial injury leading to a picture of thrombotic microangiopathy. Among the detergent ingredients ingested by the patient, sodium borate raised the highest concern as a potential toxin exacerbated further by severe hypovolaemia and consequent decrease in renal toxin excretion. As sodium borate is dialyzable, haemodialysis should be a consideration early after laundry detergent ingestion.

Key Words: acute kidney injury • cortical necrosis • detergent

Received for publication September 29, 2008. Accepted for publication October 24, 2008.


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