Dr. Maurice Lam1, Dr. Candice Khor1, Dr. Sebastian Hultin1, Dr. Jason Cheung1, Dr Nasir Ali Shah1,2,3
1Department of Nephrology, The Sutherland Hospital, Caringbah, Australia, 2Department of Nephrology, Prince of Wales Hospital, Randwick, Australia, 3School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia
Biography:
Hi my name is Maurice and I'm a basic trainee from Sydney. I completed medical school at UNSW and now I'm training at St George Hospital, the same hospital I was born in! Hobbies include video games and basketball. Career goals are still up in the air but I aspire to have well-rounded knowledge. Getting to learn more about the mysterious beans we call kidneys would be a wonderful step towards that!
Backgound:
Psilocybe cubensis mushrooms are commonly consumed for their psychoactive effects. Recently, there has been growing interest in the therapeutic potential of psilocybin-containing mushrooms in psychiatric conditions including depression, anxiety disorders, obsessive-compulsive disorder, alcohol dependence, and tobacco cessation. We report a case in which psilocybin-containing mushrooms were the presumed cause of nephrotoxicity.
Case report:
A 31-year-old male presented with acute bilateral flank pain 48-hours after ingesting 0.5 grams of psychedelic mushrooms recreationally. He developed a non-oliguric acute kidney injury with a peak serum creatinine of 189 mol/L, compared to a known baseline of 83 mol/L. The urine albumin-creatinine ratio was elevated at 40.4 mg/mmol. Urinary sediment was bland. A non-contrast computed tomography of the kidneys, ureter and bladder was unremarkable. A comprehensive glomerulonephritis screen was unrevealing. Serum electrolytes were within normal limits and there was no peripheral eosinophilia. Liver function tests were unremarkable apart from a borderline elevation in aspartate aminotransferase (39 U/L). Serum lipase was mildly elevated (82U/L). No other offending agents or contributing factors were identified on clinical history. Physical examination was unremarkable. After 48-hours of intravenous fluid therapy, his abdominal pain resolved without any further intervention. Serum creatinine improved to 136 mol/L by day 4, so a kidney biopsy was not performed.
Conclusions:
This case describes a presentation of reversible acute kidney injury potentially associated with the ingestion of psychedelic mushrooms. Although psychedelic mushrooms are generally associated with fewer toxicities, there are reported cases of hepatoxicity and/or nephrotoxicity. As the use of psychedelic agents becomes more common, awareness of their potential side effects will be critical to ensuring clinical safety.