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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">After carefully reading the article by Rojas et al &#40;Nefrolog&#237;a 2008&#59;28&#91;5&#93;&#58;559-560&#41;&#44;<span class="elsevierStyleSup">1</span> we would like to make a series of observations which we believe should be taken into account&#46; The article describes the case of a child who&#44; after consuming wild mushrooms&#44; had symptoms of vomiting without the presence of diarrhoea&#44; followed by anuric renal failure&#44; anaemia and mild hepatic cytolysis&#44; and needed haemodialysis for 8 days with satisfactory progress&#46;</p><p class="elsevierStylePara">While discussing the case&#44; the article mentions hepatotoxic mushrooms carrying amatoxins as the cause of the illness&#46; However&#44; in our opinion&#44; the absence of diarrhoea&#44; present in 100&#37; of such poisoning&#44;<span class="elsevierStyleSup">2</span> together with the mild hepatic cytolysis and the normal prothrombin time&#44; render the involvement of a hepatotoxic mushroom such as Amanita verna highly unlikely&#46;</p><p class="elsevierStylePara">The erroneous use of the references is surprising&#46; Five of the six articles mention poisoning from mushrooms of the Cortinarius genus&#44; the symptoms of which greatly differ from those described here&#46; The digestive symptoms indicate a latency of 3 days in appearance and renal failure of 4 to 15 days&#44; leading to chronic kidney disease &#40;CKD&#41; in 34&#37; of the cases without hepatic affectation in all the cases shown&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">However&#44; the case described by Rojas et al is of particular interest because it corresponded to many of the data attributed to an accelerated nephrotoxic syndrome caused by mushrooms&#44; which is described as being caused in the USA<span class="elsevierStyleSup">4</span> by the Amanita smithiana&#44; in Japan by the Amanita pseudoporphyria and in France&#44;<span class="elsevierStyleSup">5&#44;6</span> Italy and Spain<span class="elsevierStyleSup">7</span> by the Amanita proxima&#46; The latter&#44; that is&#44; Amanita proxima &#40;Dum&#233;e&#44; 1916&#41;&#44; is a mushroom with a creamy white colour similar to Amanita ponderosa or Amanita ovoidea&#44; with which it is usually confused&#46; It has an orange volva that is characteristically different from the rest of the white-coloured fungi&#44; and it is predominantly found in the Mediterranean area&#46;<span class="elsevierStyleSup">5&#44;6</span> De Haro et al&#44;<span class="elsevierStyleSup">5</span> with the greatest amount of cases &#40;53 patients&#41;&#44; report that between 2 and 48 hours following post-ingestion all patients showed signs of gastroenteritis&#44; with a high number of vomiting &#40;85&#37;&#41; and a lesser amount of diarrhoea &#40;26&#37;&#41;&#46; Leray et al&#44;<span class="elsevierStyleSup">6</span> in a smaller amount of cases&#44; report no diarrhoea&#46; Acute renal failure occurred between days one and four following ingestion&#44; always accompanied by mild cytolysis that was quickly reversible with a prevalence of LDH and GPT&#47;ALT&#44; the latter never surpassing 15 times the maximum normal limit&#46; Renal affectation is histopathologically characterised by acute tubulointerstitial nephritis with an always-favourable progress&#46;<span class="elsevierStyleSup">6</span> The toxin responsible has yet to be isolated&#59; however&#44; suggestions have been made of nonprotein amino acids&#44; thermo-stable and similar to those found in other nephrotoxic fungi&#44; for example&#44; allenic norleucine isolated in the Amanita smithiana&#46;<span class="elsevierStyleSup">4</span></p>"
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Comment on 'Acute renal failure after intake of mushrooms'
Comentario a «Insuficiencia renal aguda tras consumo de setas»
Eusebio Soto Bermejoa, J.. Piqueras Carrascob, J.. Elizalde Fernándezc
a Sección de Urgencias, Hospital Reina Sofía, Tudela, Navarra, España,
b Servicio de Hematología, Laboratorios Clínicos. Hospital Universitari Vall d¿Hebron, Barcelona, Barcelona, España,
c Servicio de Medicina Intensiva, Hospital de Navarra, Pamplona, España,
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Nefrología (English Edition)