Acute kidney injury: A rare cause

We present a young lady who consumed hair dye,which contained paraphenylene diamine (PPD),as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated,and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI). The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria,causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances,timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly,because PPD is a nondialyzable toxin,and its long-term effect necessitates its speedy removal,hemoperfusion might be helpful and is worth considering.