Acute renal failure caused by Amanita oberwinklerana poisoning

Mushrooms of the sections Lepidella and Amidella in the genus Amanita can cause acute renal injury. The paper reports the first two known cases of acute renal failure after ingestion of A. oberwinklerana in China. The cases' clinical symptoms were characterized by gastrointestinal toxicity 6 h after ingestion followed by mild hepatitis and severe acute renal failure, which are identical to the clinical symptoms of Amanita nephrotoxic syndrome. The mushroom species was identified using morphological and internal transcribed spacer (ITS) sequence data. HPLC analyses detected no amatoxins or phallotoxins in this species. The clinical syndromes and toxin profiles, as well as the phylogenetic analysis based on ITS sequences, strongly support the transfer of A. oberwinklerana from the section Phalloideae to the section Lepidella.