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Wang H, Deng L, Sun B, Xing C, Mao H, Wu B. Bromadiolone may cause severe acute kidney injury through severe disorder of coagulation: a case report. BMC Nephrol 2024; 25:303. [PMID: 39266966 PMCID: PMC11396568 DOI: 10.1186/s12882-024-03746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 09/05/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Bromadiolone is a wide-use long-acting anticoagulant rodenticide known to cause severe coagulation dysfunction. At present, there have been no detailed reports of acute kidney injury (AKI) resulting from bromadiolone poisoning. CASE PRESENTATION A 27-year-old woman was admitted to the hospital due to severe coagulopathy and severe AKI. Coagulation test revealed a prothrombin time exceeding 120 s and an international normalized ratio (INR) greater than 10. Further examination for coagulation factors showed significantly reduced level of factors II, VII, IX and X, indicating a vitamin K deficiency. The AKI was non-oliguric and characterized by gross dysmorphic hematuria. Following the onset of the disease, the patient's serum creatinine rose from 0.86 to 6.96 mg/dL. Suspecting anticoagulant rodenticide poisoning, plasma bromadiolone was identified at a concentration of 117 ng/mL via gas chromatography/mass spectrometry. All other potential causes of AKI were excluded, except for the presence of a horseshoe kidney. The patient's kidney function fully recovered after the coagulopathy was corrected with high doses of vitamin K and plasma transfusion. At a follow-up 160 days post-discharge, the coagulation function had normalized, and the serum creatinine had returned to 0.51 mg/dL. CONCLUSION Bromadiolone can induce AKI through a severe and prolonged coagulation disorder. Kidney function can be restored within days following treatment with high-dose vitamin K1.
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Affiliation(s)
- Han Wang
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Critical Care Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lingling Deng
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Critical Care Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bin Sun
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Changying Xing
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huijuan Mao
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Critical Care Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Buyun Wu
- Department of Nephrology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Critical Care Center, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Popov Aleksandrov A, Tucovic D, Kulas J, Popovic D, Kataranovski D, Kataranovski M, Mirkov I. Toxicology of chemical biocides: Anticoagulant rodenticides - Beyond hemostasis disturbance. Comp Biochem Physiol C Toxicol Pharmacol 2024; 277:109841. [PMID: 38237840 DOI: 10.1016/j.cbpc.2024.109841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
The use of anticoagulant rodenticides (ARs) is one of the most commonly employed management methods for pest rodents. ARs compete with vitamin K (VK) required for the synthesis of blood clotting factors in the liver, resulting in inhibition of blood coagulation and often animal death due to hemorrhage. Besides rodents (target species), ARs may affect non-target animal species and humans. Out of hemostasis disturbance, the effects of ARs may be related to the inhibition of proteins that require VK for their synthesis but are not involved in the coagulation process, to their direct cytotoxicity, and their pro-oxidant/proinflammatory activity. A survey of the cellular and molecular mechanisms of these sublethal/asymptomatic AR effects is given in this review. Data from field, clinical, and experimental studies are presented. Knowledge of these mechanisms might improve hazard characterization and identification of potential ecotoxicological risks associated with ARs, contributing to a safer use of these chemicals.
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Affiliation(s)
- Aleksandra Popov Aleksandrov
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Dina Tucovic
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Jelena Kulas
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Dusanka Popovic
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Dragan Kataranovski
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Milena Kataranovski
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia
| | - Ivana Mirkov
- Immunotoxicology group, Department of Ecology, Institute for Biological Research "Siniša Stanković"- National Institute of the Republic of Serbia, University of Belgrade, 142 Bulevar despota Stefana, Belgrade 11000, Serbia.
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Qian W, He C, Ren Y, Xian X, Jiang Z, Xu S. Application of nafamostat mesylate for anticoagulation in hemoperfusion therapy in patients with bromadiolone poisoning: Case reports. Heliyon 2023; 9:e19811. [PMID: 37809476 PMCID: PMC10559158 DOI: 10.1016/j.heliyon.2023.e19811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023] Open
Abstract
Bromadiolone, as a second-generation coumarin anticoagulant rodenticide, may accidently cause harm to humans and non-target animals when overused or misused due to its high toxicity and long-lasting effects. In some severe cases such as the presence of active bleeding, treatment should involve the administration of hemoperfusion therapy. Nafamostat mesylate is a synthesized protease inhibitor that inhibits most factors in the coagulation process, preventing clotting and ensuring smooth blood flow during the procedure. Nafamostat mesylate helps maintain the efficacy and safety of hemoperfusion treatment. Despite its wide application in Japan, the clinical practice and research of nafamostat mesylate are limited in China, especially for patients undergoing maintenance hemodialysis. This paper reports two cases of bromadiolone poisoning and describes the treatment procedure and therapeutic effect of anticoagulation in hemoperfusion therapy with nafamostat mesylate.
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Affiliation(s)
- Weiwei Qian
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Emergency, Shangjinnanfu Hospital, West China Hospital, Sichuan University, Chengdu, 610044, Sichuan, China
| | - Chengtong He
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yan Ren
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoyan Xian
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhen Jiang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shuyun Xu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, And Disaster Medical Center, Sichuan University, Chengdu, 610041, Sichuan, China
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