An Australian case report of reversible AKI, likely related to the ingestion of psychedelic mushrooms from the Psilocybe genus, warrants attention as interest grows in the potential therapeutic applications of psilocybin-containing mushrooms.
According to the report, published in the Internal Medicine Journal [link here], the case joins other reports of nephrotoxicity linked to psilocybin ingestion.
It raises the need for clinical caution in the emerging field of psilocybin-assisted psychotherapy for conditions including treatment-resistant depression, anxiety disorders, obsessive-compulsive disorder, and substance dependence or addictions.
“These exposures rely on correct preparation and sufficiently skilful identification of the product to ensure there are no contaminants which could contribute to the development of AKI,” the report said.
The NSW case was a male in his early 30s who presented with acute bilateral flank pain 48 hr following recreational ingestion of 0.5 g of psilocybin-containing mushrooms in dry whole form.
“He experienced the desired and expected hallucinogenic effects upon initial consumption,” the report said.
As well, he developed a non-oliguric AKI with a peak serum creatinine of 189 μmol/L, elevated from a known baseline of 83 μmol/L.
“Urinalysis demonstrated an elevated albumin-creatinine ratio (40.4 mg/mmol) and bland urinary sediment.”
Other investigations including physical examination, CT and blood tests were unremarkable, there were no symptoms suggestive of dehydration, and there were no alternative nephrotoxic exposures or contributing factors identified.
The patient received supportive management with IV fluids, resulting in resolution of flank pain within 48 hr. Serum creatinine improved to 136 μmol/L by day 4, so a kidney biopsy was not pursued.
“At 1 month follow-up, renal function had fully recovered, with his serum creatinine returning to 85 μmol/L.”
The authors of the report from the department of nephrology at the Sutherland Hospital said the serotonergic activity of psilocybin, particularly via 5-HT2A receptor agonism, may lead to vasoconstriction and tubular injury.
“As psilocybin prescribing becomes more widespread in Australia, clinical awareness of its potential renal effects is essential to ensuring patient safety,” they said.
Meanwhile, nephrotoxicity secondary to mushroom ingestion is usually associated with the orellanine-containing Cortinarius species and the amatoxin-producing Amanita species.
They said orellanine nephrotoxicity typically presents as delayed-onset AKI and often progresses to CKD requiring dialysis and transplant.
Amatoxins are classically hepatotoxic, but nephrotoxicity has been reported due to severe dehydration from profuse diarrhoea, direct tubular toxicity or secondary to hepatorenal syndrome.