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Kidney Week

Abstract: TH-PO138

A Case of Severe AKI from Cutaneous Contact with Cresol

Session Information

Category: Trainee Case Report

  • 103 AKI: Mechanisms

Authors

  • Pankow, Jonathan D., University of Texas Medical Center, Houston, Texas, United States
  • Waguespack, Dia Rose, McGovern Medical School - UTHealth - Houston, Houston, Texas, United States
  • Hninn, Wut yi, UTHealth, Houston, Texas, United States
Introduction

Cresol is a hydroxytoluene of ortho-, meta-, and para-isomers that are precursors to various compounds including household pesticides, disinfectants, and dyes. Although cresol is harmless in low concentrations in the environment, it can be inadvertently absorbed through intact skin, respiratory, and gastrointestinal tracts causing multiple organ dysfunction.

Case Description

A 29-year-old man presented to the emergency department after an accidental spill of cresol to his upper body and thighs at an alcohol-manufacturing chemical plant. He had no history of prior kidney disease. Physical exam revealed sharply demarcated dark brown discolorations with first degree burns to the exposed areas. A small amount of green urine was produced after bladder catheterization. The serum creatinine on arrival was 1.7 mg/dL, and he was oliguric despite fluid resuscitation. Liver enzymes were normal. Over the next two days the creatinine increased to 9.63 mg/dL and hemodialysis was initiated. Abdominal ultrasound and computed tomography were normal. The patient continued to require thrice weekly hemodialysis during his two-week hospitalization. Although he became non-oliguric, he was discharged with scheduled outpatient dialysis because a 24-hour creatinine clearance at time of discharge was 11 mL/minute.

Discussion

Cresol exposure is a rare cause of acute kidney injury. Previous cases of cresol toxicity have focused on ingestions that report multiple organ dysfunction with a high prevalence of liver dysfunction. Only a handful of cases describe cutaneous absorption of cresol, usually associated with severe acute kidney injury without evidence of significant liver injury. This observation is likely because cutaneous cresol absorption bypasses the portal venous system and reduces the liver’s exposure to the toxin. The cause of acute kidney injury in cases of cresol intoxication is acute tubular necrosis based on a limited number of biopsy and autopsy case studies. Treatment is supportive with the potential for requiring prolonged hemodialysis depending on extent of exposure.