Acute kidney injury secondary to exposure to insecticides used for bedbug (Cimex lectularis) control

Am J Kidney Dis. 2013 Nov;62(5):974-7. doi: 10.1053/j.ajkd.2013.04.020. Epub 2013 Jun 22.

Abstract

Bedbug (Cimex lectularis) infestation is becoming a worldwide epidemic due to the emergence of insecticide-resistant strains. Pyrethroids are approved by the US Environmental Protection Agency for use against bedbugs and are considered minimally toxic to humans, with known respiratory, neurologic, and gastrointestinal effects. We present the first reported case of pyrethroid-induced toxic acute tubular necrosis (ATN). A 66-year-old healthy woman receiving no prior nephrotoxic medications presented with extreme weakness, decreased urine output, and acute kidney injury. She had administered multiple applications of a bedbug spray (permethrin) and a fogger (pyrethrin), exceeding the manufacturer's recommended amounts. She was found to have severe nonoliguric acute kidney injury associated with profound hypokalemia. Kidney biopsy revealed toxic ATN with extensive tubular degenerative changes and cytoplasmic vacuolization. With conservative management, serum creatinine level decreased from 13.0 mg/dL (estimated glomerular filtration rate, 3 mL/min/1.73 m(2)) to 1.67 mg/dL (estimated glomerular filtration rate, 37 mL/min/1.73 m(2)) within 6 weeks. Literature review uncovered no prior report of pyrethroid insecticide-induced ATN in humans, although there are reports of ATN with similar tubular vacuolization in rats exposed to this agent. Bedbug insecticides containing pyrethroids should be used with caution due to the potential development of toxic ATN after prolonged exposure.

Keywords: Bedbug; acute kidney injury; insecticide; permethrin; pyrethrin; pyrethroids; toxic acute tubular necrosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / physiopathology
  • Aged
  • Animals
  • Bedbugs*
  • Biopsy
  • Creatinine / blood
  • Environmental Exposure*
  • Female
  • Glomerular Filtration Rate / physiology
  • Humans
  • Insecticides / adverse effects*
  • Kidney / pathology
  • Kidney / physiopathology
  • Pest Control / methods*
  • Pyrethrins / adverse effects*
  • Water-Electrolyte Balance / physiology

Substances

  • Insecticides
  • Pyrethrins
  • Creatinine