Kim Chang Seong, Kim Sung Sun, Bae Eun Hui, Ma Seong Kwon, Kim Soo Wan
Department of Internal Medicine Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Medicine (Baltimore). 2017 Dec;96(48):e8879. doi: 10.1097/MD.0000000000008879.
Povidone-iodine is a broad-spectrum antiseptic applied topically to treat wounds and prevent their infection. There have been several case reports of acute kidney injury (AKI) in burn patients after povidone-iodine irrigation and in patients receiving the substance as a sclerotherapy agent for management of lymphocele after renal transplantation. However, biopsy-confirmed AKI after ingestion of povidone-iodine has not previously been described.
A 47-year-old man who had apparently ingested povidone-iodine solution and presented with nausea, vomiting, and reduced urine output. Laboratory data revealed blood urea nitrogen of 124 mg/dL, serum creatinine of 6.3 mg/dL, impaired liver function, and leukocytosis. Urine iodine/creatinine ratio was markedly elevated.
Acute tubular necrosis and interstitial nephritis secondary to povidone-iodine ingestion.
The patient was admitted to the intensive care unit and underwent continuous venovenous hemodiafiltration. Kidney biopsy showed acute tubular necrosis and interstitial nephritis. Unstained sections showed tan objects in the tubular lumina that were suspected to be povidone-iodine casts. Corticosteroid therapy (1 mg/kg/day) was started after kidney biopsy.
Renal function recovered after hemodialysis and corticosteroid medication, but not completely.
We have reported the first case of biopsy-confirmed AKI accompanied by increased urine iodine concentration following povidone-iodine ingestion.
聚维酮碘是一种广谱抗菌剂，局部应用于治疗伤口并预防感染。已有数例关于烧伤患者在聚维酮碘冲洗后以及肾移植后接受该物质作为硬化疗法药物治疗淋巴囊肿的患者发生急性肾损伤（AKI）的病例报告。然而，此前尚未有关于摄入聚维酮碘后经活检证实的AKI的描述。
一名47岁男性，显然摄入了聚维酮碘溶液，出现恶心、呕吐和尿量减少。实验室数据显示血尿素氮为124mg/dL，血清肌酐为6.3mg/dL，肝功能受损，白细胞增多。尿碘/肌酐比值明显升高。
摄入聚维酮碘继发急性肾小管坏死和间质性肾炎。
患者入住重症监护病房并接受持续静静脉血液透析滤过治疗。肾活检显示急性肾小管坏死和间质性肾炎。未染色切片显示肾小管腔内有黄褐色物质，怀疑是聚维酮碘管型。肾活检后开始使用皮质类固醇治疗（1mg/kg/天）。
血液透析和皮质类固醇药物治疗后肾功能有所恢复，但未完全恢复。
我们报告了首例摄入聚维酮碘后经活检证实的AKI病例，伴有尿碘浓度升高。
