RESEARCH ARTICLE


Methemoglobinemia-Induced Acute Kidney Injury



Amir H. Qureshi1, Daniel J. Soberon1, Arif Asif2, Tushar Vachharajani3, Ali Nayer* , 1
1 Division of Nephrology, University of Miami, Miami, FL, USA
2 Division of Nephrology, Albany Medical College, Albany, NY, USA
3 Division of Nephrology, W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC, USA


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Ali Nayer (Eds.) All rights reserved-© 2014 Bentham Science Publishers

* Address correspondence to this author at the Division of Nephrology and Hypertension, University of Miami, Clinical Research Building, Suite 825, 1120 NW 14th St., Miami, FL 33136, USA; Tel: 305.243.8491; Fax: 305.243.3506; E-mail: ANayer@med.miami.edu


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.

Keywords: Methemoglobin, acute kidney injury, benzocaine, heme proteins.