Methemoglobinemia-induced acute kidney injury

Amir H. Qureshi, Daniel J. Soberon, Arif Asif, Tushar Vachharajani, Ali Nayer

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Introduction: Methemoglobinemia refers to the presence of increased levels of methemoglobin (Fe3+) in the blood. Methemoglobinemia can cause cyanosis, dyspnea, fatigue, seizure, arrhythmia, coma, and even death. Although methemoglobinemia is shown to cause acute kidney injury in experimental settings, human case reports are exceedingly rare. In addition, morphological features of methemoglobinemia-induced renal disease in humans remain undefined. Case Presentation: A 76-year-old man with a history of chronic obstructive pulmonary disease underwent bronchoscopy following local anesthesia with a benzocaine spray. The patient developed benzocaine-induced methemoglobinemia and acute renal failure. Urinalysis disclosed numerous dysmorphic erythrocytes, erythrocyte casts, and granular casts. Urine protein excretion was approximately 1.1 g/day. Serologic tests were negative. Renal biopsy demonstrated minor glomerular abnormalities, severe acute tubular necrosis, and numerous erythrocyte casts in the tubules. Despite supportive care, renal function deteriorated necessitating hemodialysis. Four months later, the patient remained on hemodialysis. To exclude a superimposed pathology, renal biopsy was repeated and showed numerous erythrocyte casts in the tubules and severe tubular damage. Conclusion: Methemoglobinemia can cause acute kidney injury in humans. Morphological features resemble those observed in methemoglobin-induced acute kidney injury in experimental settings. This case calls for a heightened awareness of potential adverse effects of methemoglobinemia on renal function.

Original languageEnglish (US)
Pages (from-to)36-41
Number of pages6
JournalOpen Urology and Nephrology Journal
Volume6
Issue number1
DOIs
StatePublished - Dec 1 2012

Keywords

  • Acute kidney injury
  • Benzocaine
  • Heme proteins
  • Methemoglobin

ASJC Scopus subject areas

  • Nephrology
  • Urology

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    Qureshi, A. H., Soberon, D. J., Asif, A., Vachharajani, T., & Nayer, A. (2012). Methemoglobinemia-induced acute kidney injury. Open Urology and Nephrology Journal, 6(1), 36-41. https://doi.org/10.2174/1874303X01306010036