Acute tubular necrosis after ingestion of a fertilizer containing sodium silicate

Silica nephropathy occurs after chronic heavy exposure to silica, resulting in the development of chronic kidney disease and progression to end-stage renal disease. However, acute kidney injury due to silica exposure is rare and its renal pathology remains unclear. Here, we report a case of acute sodium silica poisoning presenting as acute kidney injury. A 42-year-old man ingested a fertilizer containing sodium silicate. His serum creatinine increased by 5.06 mg/dL from 1.1 mg/dL 2 days after silicate ingestion. Owing to the decline in kidney function despite fluid therapy, a kidney biopsy was performed. The kidney showed acute tubular necrosis without infiltration of inflammatory cells. On day 5 of admission, hemodialysis was initiated to treat the hyperkalemia and oliguria, and treatment with methylprednisolone was initiated for the acute lung injury. The patient was administered 1 mg/kg of methylprednisolone intravenously daily for 2 weeks, followed by a 2-week taper. Hemodialysis was discontinued on day 10 and the patient's renal function recovered completely. However, he died on day 40 of hospitalization owing to complicated lung fibrosis and persistent pneumothorax/pneumomediastinum.