BMJ Case Reports 2017; doi:10.1136/bcr-2017-220733
  • Rare disease

Nephrotic syndrome and acute kidney injury induced by malathion toxicity

  1. Tadashi Okamoto4
  1. 1Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, Hofu, Japan
  2. 2Department of Nephrology, Iwakuni Medical Center, Iwakuni, Japan
  3. 3Department of Nephrology, Fukuoka Higashi Medical Center, Koga, Japan
  4. 4Department of Nephrology, Shunan City Shinnanyo Hospital, Shunan, Japan
  1. Correspondence to Dr Kei Yokota, m02097ky{at}
  • Accepted 1 November 2017
  • Published 9 November 2017


We treated a case of acute kidney injury and nephrotic syndrome after malathion inhalation. A 69-year-old Japanese man presented with oedema 15 days after inhalation of malathion, a widely used pesticide. Serum albumin was 2.4 g/dL, urinary protein 8.6 g/gCr and serum creatinine 2.5 mg/dL. Kidney biopsy revealed tubular cell damage, epithelial cell damage in glomeruli and diffuse foot process effacement in electron microscopy. Acute kidney injury progressed to treatment with dialysis. Renal function recovered after corticosteroid administration from the 43rd day after admission. Malathion inhalation should be ruled out as a differential diagnosis in individuals who develop acute kidney injury and nephrotic syndrome, especially in rural-dwelling patients.


  • Contributors All authors listed have contributed sufficiently to the report to be included as authors, and all those who are qualified to be authors are listed in the author byline. KY made a substantial contribution to the conception of the work and the writing of the manuscript. MF treated the patient and made a contribution to the discussion. RK made a contribution to the interpretation of pathology findings. TO made a contribution to the discussion.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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