Acute kidney injury following ingestion of Amanita section Roanokenses in Yunnan, China: a five-case clinico-toxicological series.

INTRODUCTION: Amanita section Roanokenses is a major cause of mushroom-related acute kidney injury in China, but detailed clinico-toxicological case series remain scarce. We retrospectively analyzed five acute kidney injury cases attributed to this section in Yunnan, China, from 2018 to 2025. CASE PRESENTATIONS: Five patients developed gastrointestinal symptoms 4-31 h after ingestion, followed by oliguria and a rapid rise in serum creatinine, consistent with Kidney Disease: Improving Global Outcomes stage 1-3 acute kidney injury. All received supportive treatment, and four underwent continuous renal replacement therapy (2-7 sessions). All patients recovered and were discharged after 11-27 days. The implicated mushrooms were identified by morphological and molecular methods as two A. neoovoidea, one A. pseudoporphyria, and two undescribed Amanita species within section Roanokenses. The nephrotoxin 2-amino-4,5-hexadienoic acid was detected in all specimens at concentrations ranging from 0.07 to 3.24 mg/g dry weight. DISCUSSION: This series integrates clinical course, species identification, and quantitative toxin profiling. Recognition of this toxidrome may aid early differentiation from amatoxin poisoning and support timely initiation of renal replacement therapy. CONCLUSION: Amanita section Roanokenses poisoning is a distinct nephrotoxic syndrome characterized by early gastrointestinal symptoms, delayed acute kidney injury, detectable 2-amino-4,5-hexadienoic acid, and favorable renal outcomes with prompt treatment.