A case of acute interstitial nephropathy and toxic hepatitis after short-term herbal medication / 대한내과학회지

There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.

Two Cases of Patchy Renal Vasoconstriction without Antecedent Anaerobic Exercise / 대한신장학회잡지

Patchy renal vasoconstriction is one of the reversible renal vasoconstrictions, which usually occur in healthy young men following strenuous anaerobic exercise. Analgesics, viral infection, dehydration were known to be the causes of patchy renal vasoconstriction. We experienced two cases of patchy renal vasoconstriction without antecedent anaerobic exercise. The first case is a 54-year-old woman admitted to a hospital with severe loin pain. On admission, serum creatinine was elevated to 2.2 mg/dL. Patchy areas of delayed contrast enhancement in both kidneys were observed on immediate post-contrast CT and 14 hours delayed image. This severe loin pain was initiated without anaerobic exercise. On the 4th day, her loin pain was relieved and on the 12th day of her illness, serum creatinine was normalized with supportive care. The second case is an 18- year-old man presented with pain in the both flanks. Five days earlier, operation had been performed for treatment of gynecomastia. There had been no preceding anaerobic exercise before the flank pain occurred. On admission to the hospital, laboratory studies revealed a serum creatinine 2.3 mg/dL. Computed tomography showed multiple patchy areas of enhancement in the renal parenchyma. On 12 hours delayed image, there were delayed contrast enhancement. On the sixth day, serum creatinine decreased to 1.4 mg/dl and the loin pain was subsided. Patchy renal vasoconstriction can occur without exercise, and we suggest that patchy renal vasoconstriction should be suspected in the patients suffering from acute renal failure with severe loin pain even without strenuous exercise.