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We describe a patient with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) who was found to have renal involvement with particular renal pathological findings. So far, 17 other cases, most of them from Japan, of POEMS syndrome with renal involvement, have been published. Clinical features are variable: acute renal failure with anasarca or moderate chronic renal insufficiency with mild proteinuria. This latter presentation often passes unnoticed. There is no severe hypertension, no microangiopathic hemolytic anemia. Renal biopsy shows prominent glomerular changes which are unusual and distinct from membranoproliferative glomerulonephritis (MPGN) and from glomerular thrombotic microangiopathy (TMA). Mesangial proliferation and thickening of the capillary wall with double contour on light microscopy suggest an MPGN. By immunofluorescent microscopy, no immunoglobulins or complement deposits were found. The occurrence of mesangiolytic lesions has led to the term of "mesangiolytic glomerulonephritis". The presence, on electron microscopy, of lucent subendothelial spaces could indicate TMA. But there are neither thrombi nor arteriolar changes. We are inclined to consider that the microangiopathic lesions are due to chronic injury of glomerular endothelial cells, exacerbated at outbreaks of the disease. Increased production of IL 6 could support the efficacy of corticosteroid therapy, particularly in acute clinical situations.

Cortinarius poisoning is generally caused by orellanine, a hydroxy bipyridine N, N-dioxide. This intoxication is characterized by acute nephritis which can lead to death without treatment. We reported a highly sensitive and simple fluorimetric technique to analyse orellanine by thin-layer chromatography on the basis of its characteristic photodecomposition into orelline. Using this procedure, we detected and assayed orellanine for the first time in plasma and renal biopsies of a woman who had deliberately ingested two fruit-bodies of Cortinarius orellanus. An early original treatment was carried out based on hemodialysis, combination plasmapheresis-hemoperfusion, and amino acids and diltiazem administration. These results indicate that it is now possible to make a precise diagnosis of orellanine poisoning.

Orellanin poisoning is characterized by an acute renal failure which can be lethal if the appropriate treatment is not given. A 31-year old woman was admitted to hospital 10 days after she had deliberately ingested 2 raw carpophores of the mushroom Cortinarius orellanus. Acute renal failure (creatininaemia 1,100 mumol/l) developed, requiring 6 sessions of haemodialysis, one of plasmapheresis and the administration of diltiazem and aminoacids. Plasma and tissue assays of orellanin, the mushroom's toxin, were performed by two-dimensional thin layer chromatography. Before haemodialysis and 10 days after ingestion of the poison, the plasma contained orellanin. Eighteen months after the attempted suicide, the plasma creatinine level was 181 mumol/l.

A man experienced a toxic reaction after being stung simultaneously by 175 yellow jackets. After an initial minor anaphylactoid shock he presented a delayed acute renal failure secondary to intravascular hemolysis and rhabdomyolysis. He completely recovered without sequellae after hemodialysis. A second clinical case of hymenoptera venom-induced toxic reaction is presented. A woman was stung by 65 bees at the same time and she only had minor symptoms of anaphylactoid shock associated with an extensive angioedema. No symptom of acute renal failure, myolysis or hemolysis could be detected.