Renal toxicity caused by diethylene glycol: an overview

Area of Science:

• Nephrology
• Toxicology
• Internal Medicine

Background:

• Diethylene glycol (DEG) is a toxic alcohol known for causing severe kidney damage.
• Diglycolic acid (DGA), a metabolite of DEG, is the primary agent responsible for DEG-induced nephrotoxicity.
• DEG poisoning presents a significant public health concern due to its potential for high morbidity and mortality.

Purpose of the Study:

• To provide a comprehensive overview of diethylene glycol (DEG) poisoning.
• To focus on clinical manifestations, pathophysiology, diagnostic methods, and management strategies for DEG-induced kidney injury.
• To synthesize current literature on DEG intoxication for improved clinical understanding and patient outcomes.

Main Methods:

• This study is a narrative overview based on a review of selected literature.
• The review focused on clinical findings, pathophysiology, diagnostic features (including renal biopsy morphology), and treatment of DEG poisoning.
• Literature search encompassed studies detailing DEG intoxication, its effects on the kidneys, and patient management.

Main Results:

• DEG-induced kidney injury results from proximal tubular necrosis caused by DGA.
• Pathological changes include epithelial cell vacuolization and edema, leading to tubular obstruction, anuria, and uremia.
• Clinical presentation is dose-dependent, often involving gastrointestinal symptoms, metabolic acidosis, renal failure, and neurological complications, with potential overlapping phases.

Conclusions:

• The understanding of DEG's metabolic pathways and its toxic by-product DGA is essential for effective management.
• Prompt diagnosis and intervention, including supportive care, gastric decontamination, acid-base correction, and hemodialysis, are critical.
• Improved comprehension of DEG poisoning mechanisms can aid in preventing mortality, severe sequelae, and irreversible kidney damage.