School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Wilderness Environ Med. 2021 Dec;32(4):537-544. doi: 10.1016/j.wem.2021.09.002. Epub 2021 Oct 8.
Because mushroom poisonings are increasing worldwide after ingestions of known, newly described, and formerly considered edible species, the objectives of this review are to describe the global epidemiology of nephrotoxic mushroom poisonings, to identify nephrotoxic mushrooms, to present a toxidromic approach to earlier diagnoses of nephrotoxic mushroom poisonings based on the onset of acute renal failure, and to compare the outcomes of renal replacement management strategies. Internet search engines were queried with the keywords to identify scientific articles on nephrotoxic mushroom poisonings and their management during the period of 1957 to the present. Although hepatotoxic, amatoxin-containing mushrooms cause most mushroom poisonings and fatalities, nephrotoxic mushrooms, most commonly Cortinarius species, can cause acute renal insufficiency and failure. Several new species of nephrotoxic mushrooms have been identified, including Amanita proxima and Tricholoma equestre in Europe and Amanita smithiana in the United States and Canada. In addition, the edible, hallucinogenic mushroom Psilocybe cubensis has been noted recently via mass spectrometry as a rare cause of acute renal insufficiency. Renal replacement therapies including hemodialysis are often indicated in the management of nephrotoxic mushroom poisonings, with renal transplantation reserved for extracorporeal treatment failures.
由于食用已知的、新描述的和以前认为可食用的物种后，全球范围内的蘑菇中毒事件不断增加，因此本次综述的目的在于描述肾毒性蘑菇中毒的全球流行病学，鉴定肾毒性蘑菇，根据急性肾衰竭的发生提出一种更早期诊断肾毒性蘑菇中毒的中毒表现方法，并比较不同肾脏替代治疗策略的效果。利用互联网搜索引擎的关键词检索功能，检索了 1957 年至今有关肾毒性蘑菇中毒及其治疗的科学文献。尽管含鹅膏肽类毒素的肝毒性蘑菇导致了大多数蘑菇中毒和死亡事件，但肾毒性蘑菇（最常见的是丝盖伞属）也可能导致急性肾功能不全和衰竭。已经鉴定出了几种新的肾毒性蘑菇，包括欧洲的近缘鹅膏菌和欧洲白鹅膏菌，以及美国和加拿大的史密斯鹅膏菌。此外，通过质谱法发现，食用致幻蘑菇裸盖菇素蕈（Psilocybe cubensis）也可能导致罕见的急性肾功能不全。肾毒性蘑菇中毒的治疗通常需要包括血液透析在内的肾脏替代疗法，只有在体外治疗失败时才会考虑进行肾移植。
