What are the effects of drinking antifreeze on the kidneys and can it cause kidney stones?

From the Guidelines

Drinking antifreeze is extremely dangerous and can cause severe kidney damage, but it does not typically cause kidney stones. Antifreeze contains ethylene glycol, which is metabolized in the liver to toxic compounds that directly damage kidney cells and can lead to acute kidney failure, as noted in a systematic review and recommendations from the EXTRIP workgroup 1. When ingested, ethylene glycol initially causes symptoms similar to alcohol intoxication, followed by metabolic acidosis, cardiovascular problems, and kidney failure within 24-72 hours. The toxic metabolites crystallize in kidney tubules, causing obstruction and inflammation that can permanently destroy kidney tissue.

Key Considerations

• The primary concern with antifreeze ingestion is the potential for severe kidney damage and acute kidney failure, rather than the formation of kidney stones.
• Treatment requires immediate medical attention and includes fomepizole or ethanol administration to block ethylene glycol metabolism, along with hemodialysis to remove the toxin from the bloodstream.
• Kidney damage from antifreeze poisoning is often irreversible and may require long-term dialysis or kidney transplantation.

Recommendations

• If you suspect someone has consumed antifreeze, call poison control (1-800-222-1222) or go to an emergency room immediately, as prompt treatment significantly improves outcomes.
• Increased fluid intake is recommended to prevent recurrent nephrolithiasis, but this is not directly related to antifreeze ingestion, as noted in a clinical practice guideline from the American College of Physicians 1.

Important Note

While the provided evidence discusses various aspects of kidney stone prevention and treatment, the critical issue with antifreeze ingestion is its toxic effect on the kidneys, which is a separate concern from kidney stone formation. Therefore, the focus should be on immediate medical treatment to mitigate kidney damage rather than on preventive measures for kidney stones.

From the Research

Effects of Drinking Antifreeze on the Kidneys

• Drinking antifreeze, which contains ethylene glycol (EG), can have toxic effects on the kidneys, even in small amounts 2.
• The ingestion of EG can lead to acute renal failure, as seen in a case where an 18-year-old man ingested a relatively small amount of antifreeze and developed severe renal dysfunction 2.
• Examination of the renal biopsy specimen in this case revealed degeneration of the renal tubular epithelium and presence of intratubular calcium oxalate crystals, which can be associated with kidney stone formation 2.

Relationship Between Antifreeze Ingestion and Kidney Stones

• While there is no direct evidence that drinking antifreeze causes kidney stones, the formation of calcium oxalate crystals in the kidneys, as seen in the case mentioned earlier, can increase the risk of developing kidney stones 2.
• However, other studies have reported cases of antifreeze poisoning where patients did not develop kidney stones, despite experiencing severe renal dysfunction 3, 4, 5.

Treatment and Outcome of Antifreeze Poisoning

• Treatment for antifreeze poisoning typically includes basic supportive care, alcohol dehydrogenase inhibition, and hemodialysis 3, 5.
• Early diagnosis and treatment are crucial in preventing irreversible acute renal failure and other organ damage 6.
• In some cases, patients have made a full recovery from antifreeze poisoning with intensive treatment, including hemodialysis and supportive care 4, 5.