TY  - JOUR
PY  - 2017//
TI  - Serum creatinine and cystatin C provide conflicting evidence of acute kidney injury following acute ingestion of potassium permanganate and oxalic acid
JO  - Clinical toxicology (Philadelphia, Pa.)
A1  - Wijerathna, Thilini Madushanka
A1  - Gawarammana, Indika Bandara
A1  - Dissanayaka, Dhammika Menike
A1  - Palanagasinghe, Chathura
A1  - Shihana, Fathima
A1  - Dassanayaka, Gihani
A1  - Shahmy, Seyed
A1  - Endre, Zoltan Huba
A1  - Mohamed, Fahim
A1  - Buckley, Nicholas Alan
SP  - 970
EP  - 976
VL  - 55
IS  - 9
N2  - AIM: Acute kidney injury (AKI) is common following deliberate self-poisoning with a combination washing powder containing oxalic acid (H2C2O4) and potassium permanganate (KMnO4). Early and rapid increases in serum creatinine (sCr) follow severe poisoning. We investigated the relationship of these increases with direct nephrotoxicity in an ongoing multicenter prospective cohort study in Sri Lanka exploring AKI following poisoning.  METHODS: Multiple measures of change in kidney function were evaluated in 48 consenting patients who had serial sCr and serum cystatin C (sCysC) data available.  RESULTS: Thirty-eight (38/48, 79%) patients developed AKI (AKIN criteria). Twenty-eight (58%) had AKIN stage 2 or 3. Initial increases in urine creatinine (uCr) excretion were followed by a substantial loss of renal function. The AKIN stage 2 and 3 (AKIN2/3) group had very rapid rises in sCr (a median of 118% at 24 h and by 400% at 72 h post ingestion). We excluded the possibility that the rapid rise resulted from the assay used or muscle damage. In contrast, the average sCysC increase was 65% by 72 h.  CONCLUSIONS: In most AKI, sCysC increases to the same extent but more rapidly than sCr, as sCysC has a shorter half-life. This suggests either a reduction in Cystatin C production or, conversely, that the rapid early rise of sCr results from increased production of creatine and creatinine to meet energy demands following severe oxidative stress mediated by H2C2O4 and KMnO4. Increased early creatinine excretion supports the latter explanation, since creatinine excretion usually decreases transiently in AKIN2/3 from other causes.<p /> <p>Language: en</p>
LA  - en
SN  - 1556-3650
UR  - http://dx.doi.org/10.1080/15563650.2017.1326607
ID  - ref1
ER  -