Organophosphate pesticides (OPs) have a deleterious effect on the nervous system but they can also affect other systems and organs. Respiratory and cardiac complications are common, but the pathophysiology of nephrologic damage has not been fully studied.

We report a case of voluntary intoxication with Ultracide 40® (Methidathion at 420g/L) presenting on admission a suggestive clinical picture of poisoning with a cholinesterase inhibitor. The assay for butyrylcholinesterase (BChE) activity confirmed the poisoning. In addition to symptomatic and evacuation treatment, the patient received antidotal treatment with atropine and pralidoxime. The patient presented on day 4 oligo-anuria with hyponatremia, hyperkalemia, hyperuremia and metabolic acidosis which evolved to Acute Kidney Injury (AKI) thus requiring daily hemodialysis sessions in combination with pralidoxime. This evolution was biologically and clinically favorable.

Sporadic case reports of AKI secondary to OPs poisoning have been described in the scientific literature. These cases were successfully treated with pralidoxime combined with hemoperfusion or hemodialysis.

Acute OPs poisoning can also induce AKI. Hemodialysis could counteract the toxic effects of OPs by maintaining the acid-base balance and minimizing the harmful effects of OPs on the kidneys. Randomized Controlled Trial (RCT) studies of dose adjustment of pralidoxime in cases of renal failure are needed to establish good management guidelines.