Acute kidney injury: A rare cause.
We present a young lady who consumed hair dye, which contained paraphenylene diamine (PPD), as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated, and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI). The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria, causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances, timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly, because PPD is a nondialyzable toxin, and its long-term effect necessitates its speedy removal, hemoperfusion might be helpful and is worth considering.
Department of Nephrology, Armed Forces Medical College and Command Hospital Southern Command, Pune, India.
Satish
S
Mendonca
Satish
S
Barki
Mayank
M
Mishra
R S V
RS
Kumar
Devika
D
Gupta
Pooja
P
Gupta
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D006202:Hair Dyes / Q000506:poisoning*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D010655:Phenylenediamines / Q000506:poisoning*; D013406:Suicide, Attempted; D013997:Time Factors; D017211:Treatment Failure
D006202:Hair Dyes; D010655:Phenylenediamines; C029728:4-phenylenediamine