title: From diamonds to black stone; myth to reality: Acute kidney injury with paraphenylene diamine poisoning.
abstract: OBJECTIVE
  We report here, a case series of patients with acute kidney injury (AKI) after ingestion of paraphenylene diamine (PPD) a derivative of analine. It is used as a colouring agent to dye hair, fur and plastic and in photographic films.
  
  
  METHODS
  Subjects for the study reported here comprised a cohort of 100 patients coming to this institution with AKI following PPD poisoning. AKI was defined according to RIFLE criteria and PPD poisoning on the basis of history and presenting features. All patients had normal sized kidneys on ultrasonography and no previous co- morbidity.
  
  
  RESULTS
  One hundred patients with AKI after PPD exposure were brought to this institute between May 2010 and February 2015. Among these, 56 were females, with mean age of 23.11 ± 7.94 years. Cause of AKI was toxic rhabdomyolysis as indicated by marked rise in muscle enzymes with mean lactate dehydrogenase and creatinine phosphokinase levels of 6665.22 ± 6272.04 and 194 486.66 ± 301 905.80, respectively. Hepatotoxicity with raised aspartate aminotransferase and alanine aminotransferase was a main feature of the studied population. Renal replacement was required in 97% of patients. Complete renal recovery was observed in 77 patients, while 16 died during the acute phase of illness. Respiratory failure and recurrent hyperkalaemia were the main causes of mortality.
  
  
  CONCLUSIONS
  Easy availability and low cost of PPD has lead to a remarkable increase in the use of this substance, especially for suicidal purposes. Awareness of its effects among health professionals, as well as at a societal and government level, is needed at this time.
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Rubina
authors.initials: R
authors.lastname: Naqvi
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Fazal
authors.initials: F
authors.lastname: Akhtar
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Uzma
authors.initials: U
authors.lastname: Farooq
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Sumaira
authors.initials: S
authors.lastname: Ashraf
authors.affiliation: Department of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan.
authors.forename: Syed Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002423:Cause of Death; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology; D004396:Coloring Agents / Q000506:poisoning*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000175:diagnosis; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008297:Male; D010154:Pakistan; D010655:Phenylenediamines / Q000506:poisoning*; D017582:Renal Replacement Therapy; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000175:diagnosis; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000175:diagnosis; D018570:Risk Assessment; D012307:Risk Factors; D013406:Suicide, Attempted; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004396:Coloring Agents; D010655:Phenylenediamines; C029728:4-phenylenediamine
keywords: RIFLE criteria; acute kidney injury; hepatotoxicity; paraphenylene diamine; rhabdomyolysis