Tubular Interstitial Nephritis Secondary to Herbal Consumption: Case Report and Literature Review
Main Article Content
Abstract
Acute tubular interstitial nephritis is a form of immune-mediated renal injury characterized by infiltration of immune cells in the renal tubulointerstitium, leading to oliguric or non-oliguric acute kidney injury. It manifests with systemic arterial hypertension, foamy urine, and sometimes with secondary anemia if there is progression to chronic renal disease. The diagnosis of certainty is made by biopsy, the initial treatment consists of identifying and removing the triggering agent to avoid further exposure to toxins, management of the acute renal lesion and in some cases, it may be decided to start corticosteroids to avoid progression to end-stage chronic kidney disease. We present the case of a 24-year-old female patient with a history of consumption of unspecified herbal medicine for aesthetic purposes 3 years prior to our evaluation, who debuted with hypertensive emergency manifested by hypertensive retinopathy, hypertensive renal vasculopathy and tubulointerstitial nephritis, successfully treated with the withdrawal of the aggressor agent, angiotensin converting enzyme inhibitors, nitrates and corticosteroids. After 6 months of follow-up, the patient is asymptomatic and with total recovery of the renal disease documented by normal creatinine in laboratory tests.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Perazella MA, Rosner MH. Drug-Induced Acute Kidney Injury. Clin J Am Soc Nephrol. 2022 Aug;17(8):1220-1233. doi: 10.2215/CJN.11290821.
II. Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring. Pediatr Nephrol. 2017 Apr;32(4):577-587. doi: 10.1007/s00467-016-3394-5.
III. Perazella MA, Markowitz GS. Drug-induced acute interstitial nephritis. Nat Rev Nephrol 2010;6(8):461–70.
IV. Eddy AA. Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways. Pediatr Nephrol. 2020 Apr;35(4):547-554. doi: 10.1007/s00467-019-04207-9.
V. Nortier JL, Vanherweghem JL. For patients taking herbal therapy – lessons from aristolochic acid nephropathy. Nephrol. Dial. Transplant. 2007; 22: 1512–17.
VI. Kiliś-Pstrusińska K, Wiela-Hojeńska A. Nephrotoxicity of Herbal Products in Europe-A Review of an Underestimated Problem. Int J Mol Sci. 2021 Apr 16;22(8):4132. doi: 10.3390/ijms22084132.
VII. Yang CS, Lin CH, Chang SH, Hsu HC. Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs. Am. J. Kidney Dis. 2000; 35: 313–18.
VIII. Jha V. Herbal medicines and chronic kidney disease. Nephrology (Carlton). 2010 Jun;15 Suppl 2:10-7. doi: 10.1111/j.1440-1797.2010.01305.x
IX. Raghavan R, Shawar S (2017) Mechanisms of drug-induced inter- stitial nephritis. Adv Chronic Kidney Dis 24:64–71
X. Quattrocchi U. World Dictionary of Medicinal and Poisonous Plants (Vol. 5). Boca Raton, FL: CRC Press; 2012; pp. 300-306.
XI. Quan Y, Jin L, Luo K, Jin J, Lim SW, Shin YJ, Ko EJ, Chung BH, Yang CW. Assessment of nephrotoxicity of herbal medicine containing aristolochic acid in mice. Korean J Intern Med. 2020 Mar;35(2):400-407. doi: 10.3904/kjim.2018.280.
XII. Yang B, Xie Y, Guo M, Rosner MH, Yang H, Ronco C. Nephrotoxicity and Chinese Herbal Medicine. Clin J Am Soc Nephrol. 2018 Oct 8;13(10):1605-1611. doi: 10.2215/CJN.11571017. Epub 2018 Apr 3.
XIII. Ruebner RL, Fadrowski JJ. Tubulointerstitial Nephritis. Pediatr Clin North Am. 2019 Feb;66(1):111-119. doi: 10.1016/j.pcl.2018.08.009.
XIV. Buysen JG, Houthoff HJ, Krediet RT, Arisz L (1990) Acute inter- stitial nephritis: a clinical and morphological study in 27 patients. Nephrol Dial Transplant 5:94–99.
XV. Gonzalez E, Gutierrez E, Galeano C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 2008;73(8):940–6.
XVI. Moledina DG, Perazella MA (2018) Treatment of drug-induced acute tubulointerstitial nephritis: the search for better evidence. Clin J Am Soc Nephrol 13:1785–1787.