草酸二甲酯中毒相关肾损伤的临床病理特征及转归

Clinicopathological characteristics and outcomes of kidney injury associated with dimethyl oxalate poisoning

目的:分析草酸二甲酯(DMO)中毒患者的临床病理特征、治疗及结局,为临床救治提供依据。方法:分析国家肾脏疾病临床医学研究中心3例DMO中毒相关肾损伤患者资料,复习文献并总结此类中毒患者的临床表现、病理特征、治疗和结局。结果:3例男性患者在接触DMO后均发生严重的急性肾损伤(AKI),经肾活检病理证实为急性草酸盐肾病,接受血液净化、充分水化、抗炎等治疗后,肾功能均较前好转。文献报道的21例经皮肤直接接触或呼吸道吸入DMO中毒患者,95.2%有不同程度血清肌酐升高,52.4%达到AKI 3期;61.9%行临时血液净化,23.8%接受糖皮质激素治疗;9.5%死于多脏器功能衰竭,71.4%肾功能恢复正常。结论:DMO中毒以AKI和大量草酸盐沉积为特征,血液净化、充分水化、枸橼酸盐和小剂量激素可能是有效的治疗手段,大部分患者肾功能可恢复正常。

Objective:Analyze the clinicopathological features,treatment strategy,and outcomes of patients suffering from DMO poisoning.Methodology:This study presented three cases of nephropathy associated with DMO poisoning at our center.Additionally,a literature review was conducted to summarize the clinicopathological features,treatment strategies,and outcomes of acute DMO poisoning.Results:Three male patients developed severe acute kidney injury(AKI)subsequent to DMO exposure.Renal biopsy confirmed the diagnosis of acute oxalate nephropathy.Following treatment strategies that included hemodialysis,adequate hydration,and anti-inflammatory agents,all patients exhibited improvement in renal function.A literature review of 21 reported cases of DMO poisoning,via dermal contact or respiratory exposure,revealed that 95.2%exhibited varying degrees of elevated serum creatinine levels,and 52.4%were identified with AKI stage 3.61.9%of the patients underwent hemodialysis,while 23.8%were treated with glucocorticoids.9.5%of the patients succumbed to multiple organ failure,whereas 71.4%achieved normal renal function.Conclusion:DMO poisoning is characterized by acute kidney injury,with oxalate crystals observed in renal pathological findings.Therapeutic interventions such as hemodialysis,hydration,citrate solutions,and low-dose glucocorticoids may offer clinical benefits post-intoxication.The majority of the patients experienced a recovery of kidney function.