2-Methyl-4-chlorophenoxyacetic acid (MCPA) is a widely used chlorophenoxy herbicide. MCPA poisoning causes mitochondrial dysfunction, which can lead to kidney injury and death. The objective of this study is to describe the epidemiology, case fatality and extent of renal injury in a large cohort of MCPA self-poisonings. The study consists of two parts: (1) A report of epidemiological data and clinical outcomes in MCPA poisoned patients in Sri Lanka between 2002 and 2019; (2) Evaluation of acute kidney injury (AKI) using renal biomarkers in a subset from this cohort. Serum creatinine (sCr) and biomarkers were measured soon after hospitalization (2 [IQR 1–3] h) and at different time intervals. We measured serum biomarkers: sCr, cystatin C (sCysC), creatine kinase (CK), and urinary biomarkers: creatinine, kidney injury molecule-1 (KIM-1), clusterin, albumin, beta-2-microglobulin (β2M), cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), trefoil factor 3 (TFF3) and cytochrome C (CytoC). Kidney Disease Improving Global Outcomes (KDIGO) criteria was used to define acute kidney injury (AKI). There were 1653 patients; 65% were male. The median time from ingestion to examination was 3:54 (IQR 2:19–6:57) h. The overall case-fatality rate was 5.3%. Patients who died were older (42 [IQR 33.5–54] vs 27 [IQR 20–37] for survivors). The median estimated amount of MCPA ingested by patients who died was also greater (88 [IQR 34–200] vs. 30 [IQR 15–63] ml in survivors). Moderate to severe AKI (AKI2/3) was uncommon (6/59 patients in the biomarker study had KDIGO stage 2 or 3). Most patients in AKI2/3 group with increased sCr were older (median age 35 years [IQR 27–41]) compared to No AKI (23 years (19–29) years) or AKI1 (26 years (21–40) years) group who had no or mild increase in sCr. These patients had no pre-existing kidney diseases. In these patients, serum creatinine (maximum medium concentration; 1.12 [IQR 0.93–1.67] mg/dl) and CK (maximum medium concentration; 284 [IQR 94–428] U/l) were increased but sCysC (maximum medium concentration; 0.79 [IQR 0.68–0.81] mg/l) remained in the normal range within 72 h. All urinary biomarkers performed poorly in diagnosing AKI (area under the receiver operating characteristic curve < 0.68). The higher numbers of men with MCPA poisoning likely reflects greater occupational access to pesticides. Fatal outcome and higher ingested dose were more common in the elderly. Significant AKI with tubular injury biomarkers was uncommon. Most people with raised sCr were older and appeared to have no pre-existing kidney disease.

2-Methyl-4-chlorophenoxyacetic acid (MCPA) 是一种广泛使用的氯苯氧基除草剂。MCPA 中毒会导致线粒体功能障碍，从而导致肾脏损伤和死亡。本研究的目的是描述大量 MCPA 自中毒患者的流行病学、病死率和肾损伤程度。该研究包括两部分：（1）斯里兰卡 2002 年至 2019 年 MCPA 中毒患者的流行病学数据和临床结果报告；(2) 在该队列的子集中使用肾脏生物标志物评估急性肾损伤 (AKI)。住院后不久（2 [IQR 1-3] 小时）并在不同的时间间隔测量血清肌酐 (sCr) 和生物标志物。我们测量了血清生物标志物：sCr、胱抑素 C (sCysC)、肌酸激酶 (CK) 和尿液生物标志物：肌酐、肾损伤分子 1 (KIM-1)、凝聚素、C(CytoC)。肾脏疾病改善全球预后 (KDIGO) 标准用于定义急性肾损伤 (AKI)。有1653名患者；65% 是男性。从摄入到检查的中位时间为 3:54 (IQR 2:19–6:57) h。总病死率为5.3%。死亡的患者年龄较大（42 [IQR 33.5–54] vs 27 [IQR 20–37] 为幸存者）。死亡患者摄入的 MCPA 估计中位数也更大（88 [IQR 34-200] vs. 30 [IQR 15-63] ml 幸存者）。中度至重度 AKI (AKI2/3) 并不常见（生物标志物研究中有 6/59 名患者患有 KDIGO 2 期或 3 期）。与无 AKI（23 岁（19-29）岁）或 AKI1（26 岁（21-40）岁）相比，AKI2/3 组中 sCr 升高的大多数患者年龄较大（中位年龄 35 岁 [IQR 27-41]） sCr 没有或轻度增加的组。这些患者没有预先存在的肾脏疾病。在这些患者中，血清肌酐（最大介质浓度；1.12 [IQR 0.93–1.67] mg/dl）和 CK（最大介质浓度；284 [IQR 94–428] U/l）升高，但 sCysC（最大介质浓度；0.79 [IQR 0.68–0.81] mg/l) 在 72 小时内保持在正常范围内。所有尿液生物标志物在诊断 AKI 方面表现不佳（受试者工作特征曲线下面积 < 0.68）。患有 MCPA 中毒的男性人数较多可能反映了更多的职业接触杀虫剂。致命结果和较高的摄入剂量在老年人中更为常见。具有肾小管损伤生物标志物的显着 AKI 并不常见。大多数 sCr 升高的人年龄较大，并且似乎没有预先存在的肾脏疾病。67] mg/dl) 和 CK（最大培养基浓度；284 [IQR 94–428] U/l）增加，但 sCysC（最大培养基浓度；0.79 [IQR 0.68–0.81] mg/l）保持在正常范围内72 小时。所有尿液生物标志物在诊断 AKI 方面表现不佳（受试者工作特征曲线下面积 < 0.68）。患有 MCPA 中毒的男性人数较多可能反映了更多的职业接触杀虫剂。致命结果和较高的摄入剂量在老年人中更为常见。具有肾小管损伤生物标志物的显着 AKI 并不常见。大多数 sCr 升高的人年龄较大，并且似乎没有预先存在的肾脏疾病。67] mg/dl) 和 CK（最大培养基浓度；284 [IQR 94–428] U/l）增加，但 sCysC（最大培养基浓度；0.79 [IQR 0.68–0.81] mg/l）保持在正常范围内72 小时。所有尿液生物标志物在诊断 AKI 方面表现不佳（受试者工作特征曲线下面积 < 0.68）。患有 MCPA 中毒的男性人数较多可能反映了更多的职业接触杀虫剂。致命结果和较高的摄入剂量在老年人中更为常见。具有肾小管损伤生物标志物的显着 AKI 并不常见。大多数 sCr 升高的人年龄较大，并且似乎没有预先存在的肾脏疾病。所有尿液生物标志物在诊断 AKI 方面表现不佳（受试者工作特征曲线下面积 < 0.68）。患有 MCPA 中毒的男性人数较多可能反映了更多的职业接触杀虫剂。致命结果和较高的摄入剂量在老年人中更为常见。具有肾小管损伤生物标志物的显着 AKI 并不常见。大多数 sCr 升高的人年龄较大，并且似乎没有预先存在的肾脏疾病。所有尿液生物标志物在诊断 AKI 方面表现不佳（受试者工作特征曲线下面积 < 0.68）。患有 MCPA 中毒的男性人数较多可能反映了更多的职业接触杀虫剂。致命结果和较高的摄入剂量在老年人中更为常见。具有肾小管损伤生物标志物的显着 AKI 并不常见。大多数 sCr 升高的人年龄较大，并且似乎没有预先存在的肾脏疾病。