Contrast-induced acute kidney injury following iodine opacification other than by intravascular injection

Povidone-Iodine-Induced Acute Kidney Injury in a 23-Year-Old Woman: The First Clinical Case Report From the Republic of Cyprus

Povidone-iodine (PI) is considered a generally safe broad-spectrum, antiseptic substance, which is widely used in healthcare services, mostly for burn patients, in wound treatment, surgical wound irrigation, as well as for a few gynecological indications. Although it is safe, its use on mucosa can cause toxicity due to iodine absorption and the high concentration in the serum. PI toxicity is absorption depended and has been associated with severe adverse events including acute kidney injury (AKI). To our knowledge, there are only three cases of PI-induced AKI after uterine instillation in the published literature. We report a case of severe PI-induced AKI that occurred in a 23-year-old female due to iodine systemic absorption immediately post uterine instillation, in terms of infertility evaluation.

The patient was admitted to the intensive care unit (ICU), supported with mechanical ventilation and treated with renal replacement therapy (RRT). Renal function and urine output improved and the patient was discharged from ICU.

Severe adverse events may be linked to internal use, therefore, PI on mucosa should be used with extreme caution. Clinicians should be aware of iodine intoxication and possible AKI.

Toxicological evaluation of repeated administration of povidone iodine in cockerels

Povidone-iodine (Polidine®) is a synthetic broad-spectrum antiseptic being applied topically to treat wounds and prevent their infection. It has been however reported with the assertions that it is effective in the treatment of infectious bursa disease (IBD) when administered orally by practicing Veterinarians and other poultry handlers. Acute kidney injury has been reported also with povidone iodine ingestion. Hence, in this study, graded dose administration was conducted to ascertain its safety profile. Forty chicks were obtained from a poultry hatchery in Ibadan, Oyo State. They were randomly divided into four (4) groups of ten chicks each. Group I served as negative control, groups II, III and IV were administered Polidine® at 1 mL/50 L, 1 mL/25 L, and 1 mL/10 L of water respectively for 7 days. Blood samples were collected on Days 3 and 7 post administration for determination of haematological and biochemical parameters. Liver and Kidney tissues were harvested following termination of the experiment and processed for histopathological examination. Results revealed no significant (p > 0.05) effect in the haematological and biochemical parameters of cockerels treated with Povidone iodine at 1 mL/50 and 25 L of water. On histopathological examination no lesion was also observed in the liver and kidney tissues of groups I, II and III (normal control, 1 mL/50 and 25 L respectively) when compared to group IV (1 mL PI /50 L of water) where lesions were recorded. Hence, this study has shown the relative safety of povidone iodine at different doses in cockerels.

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Povidone iodine treatment at 1 mL/50 and 25 L of water had no haematological effect.

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Povidone iodine administered at 1 mL/50 and 25 L of water had no biochemical effect.

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Povidone iodine given at 1 mL/50 and 25 L of water had no histopathological lesions.

A case of severe nephrotoxicity associated with long-term dietary supplement use

Dietary supplements are widely used for their perceived health benefits without side effects and hence have minimal regulation. However, they have been associated with various toxicities including kidney disease. We report a 65-year-old male who had very heavy daily intake of dietary supplements for 3 years. He presented with acute kidney injury and nephrotic-range proteinuria. The renal biopsy showed acute tubular necrosis with vacuolization, acute interstitial nephritis, and secondary membranous nephropathy, consistent with an non-steroidal anti-inflammatory drug (NSAID)-like nephropathy. This was postulated to be related to the cyclooxygenase (COX) inhibitors (anthocyanins) in cherry extract that was a significant part of the patient's dietary supplement use. His proteinuria completely resolved and serum creatinine stabilized after discontinuation of all dietary supplements and a prolonged (5 months) course of prednisone. Clinicians are advised to specifically inquire about dietary supplements, especially cherry extract, as a potential cause of new-onset renal failure and proteinuria.
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