Institute of Microbiology, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.
Nephrol Dial Transplant. 2012 Apr;27(4):1380-6. doi: 10.1093/ndt/gfr511. Epub 2011 Sep 29.
Renal failure as a consequence of eating mushrooms has been reported repeatedly after ingestion of webcaps of the Cortinarius orellanus group. But mushrooms of the genus Amanita can also cause renal failure: Amanita smithiana (North America) and Amanita proxima (Mediterranean area). Here, we discuss poisonings caused by other white amanitas. A German and--independently--two Portuguese patients reported the ingestion of completely white mushrooms with ring. Similar to intoxications with A. smithiana or A. proxima, the clinical picture was characterized by nausea and vomiting 10-12 h after ingestion, severe acute renal failure and mild hepatitis. Renal biopsy showed acute interstitial nephritis and tubular necrosis. Two patients were given temporary haemodialysis. All have fully recovered their renal function. Poisonings caused by mushrooms containing the toxin of A. smithiana were suspected. We tested 20 Amanita species for the presence of this toxin.
Thin layer chromatography was applied to detect A. smithiana nephrotoxin in herbarium specimens using authentic material of A. smithiana as reference.
A. smithiana toxin could be detected in Amanita boudieri, Amanita gracilior and in Amanita echinocephala. A. boudieri was collected by the Portuguese patients. A. echinocephala is the only nephrotoxic Amanita growing North of the Alps and is suspected to be the cause of renal failure in the German patient. No A. smithiana toxin was detectable in the nephrotoxic A. proxima.
A. boudieri, A. gracilior and A. echinocephala are nephrotoxic. These intoxications are clinically similar to that of A. smithiana, with acute reversible renal failure and mild hepatitis but are different in their clinical picture from Orellanus syndrome characterized by a delayed onset of severe and often irreversible renal failure.
摄入 Orellanus 组网帽 Cortinarius 蘑菇后，反复报道了肾功能衰竭作为后果。但是鹅膏菌属蘑菇也会导致肾功能衰竭：Amanita smithiana（北美）和 Amanita proxima（地中海地区）。在这里，我们讨论了其他白鹅膏菌引起的中毒。一名德国人和——独立地——两名葡萄牙患者报告说摄入了带有环的完全白色蘑菇。与 A. smithiana 或 A. proxima 中毒相似，临床表现为摄入后 10-12 小时出现恶心和呕吐、严重急性肾功能衰竭和轻度肝炎。肾活检显示急性间质性肾炎和肾小管坏死。两名患者接受了临时血液透析。所有患者的肾功能均完全恢复。怀疑是摄入了含有 A. smithiana 毒素的蘑菇所致。我们测试了 20 种鹅膏菌，以检测是否存在这种毒素。
使用 A. smithiana 的真实材料作为参考，通过薄层层析法检测标本中存在的 A. smithiana 肾毒素。
A. smithiana 毒素可在 Amanita boudieri、Amanita gracilior 和 Amanita echinocephala 中检测到。A. boudieri 是由葡萄牙患者采集的。A. echinocephala 是阿尔卑斯山以北唯一的肾毒性鹅膏菌，怀疑是德国患者肾功能衰竭的原因。在肾毒性 A. proxima 中未检测到 A. smithiana 毒素。
A. boudieri、A. gracilior 和 A. echinocephala 具有肾毒性。这些中毒与 A. smithiana 相似，表现为急性可逆性肾功能衰竭和轻度肝炎，但与以严重且通常不可逆的肾功能衰竭为特征的 Orellanus 综合征的临床表现不同。
