Reversible acute renal failure due to Chinese herbs

ABSTRACT

Recently, herb induced nephropathy has been described as a subgroup of renal disorders. Patients taking Chinese herbs for eczema and weight reduction have been reported to develop chronic interstitial nephritis, rapidly progressive interstitial fibrosis and urothelial malignancies. An agent, known as aristolochic acid [AA], isolated from such herbs has been identified as an independent and direct nephrotoxin. The pathology by which AA incurs renal damage is yet to be determined. With regards to malignancies triggered by such herbs, these patients have been found to over express a mutated p53 gene. Here, we discuss the management of a young female patient who developed biopsy proven acute interstitial nephritis with early fibrosis after ingesting a herbal remedy for a short period of time. Other causes of interstitial nephritis in this patient such as viral infections and autoimmune disorders were investigated and ruled out. Initially, she presented with acute renal failure requiring hemodialysis for ten days. Fortunately, she did not develop any permanent renal dysfunction as the etiology was identified early and the herbs were discontinued immediately. Her renal impairment reversed to normal within a one-month period after a trial of corticosteroids was administered. We believe this is the first of such cases isolated in Saudi Arabia