Ajmal Muhammad S, Awosika-Olumo Adebowale, Raghavan Rajeev
Nephrology, Baylor College of Medicine, Houston, USA.
Epidemiology, Walden University, Houston, USA.
Cureus. 2020 Feb 11;12(2):e6950. doi: 10.7759/cureus.6950.
Unregulated traditional medications and their solvents are nephrotoxic. We present a case of a 49-year-old Nigerian male with a 10-year history of diabetes mellitus and hypertension who was ingesting a traditional, herbal medication as an aphrodisiac for erectile dysfunction. He had a rapid decline in kidney function over a period of one year and the patient commenced thrice weekly hemodialysis. He came to the USA for a second opinion. A full laboratory evaluation for immunologic and infectious causes of kidney failure was unremarkable. Kidneys were 12 cm bilaterally and a kidney biopsy revealed protracted tubular injury with isometric vacuolization and numerous calcium oxalate crystals. His serum oxalate level was elevated and there was no evidence of primary hyperoxaluria. It was suspected that the daily use of traditional, herbal supplements which often contain ethylene or diethylene glycol-based solvents may have led to a chronic oxalate toxicity that resulted in his kidney failure and above-mentioned pathological findings. Kidney damage was deemed irreversible and the patient returned to Nigeria. Worldwide, the increasing use of unregulated traditional, herbal supplements has the potential to cause epidemics of kidney disease in rural communities. A thorough medication history including the use of traditional and herbal supplements should be obtained in all patients with a rapid decline in kidney function, even in the presence of known risk factors for chronic kidney disease (CKD).
不受监管的传统药物及其溶剂具有肾毒性。我们报告一例49岁的尼日利亚男性病例，该患者有10年糖尿病和高血压病史，因勃起功能障碍服用一种传统草药作为壮阳药。他的肾功能在一年内迅速下降，随后开始每周进行三次血液透析。他前往美国寻求第二种意见。对肾衰竭的免疫和感染原因进行的全面实验室评估无异常发现。双侧肾脏大小均为12厘米，肾脏活检显示持续性肾小管损伤，伴有等距空泡形成和大量草酸钙结晶。他的血清草酸盐水平升高，且无原发性高草酸尿症的证据。怀疑每日服用通常含有基于乙二醇或二甘醇的溶剂的传统草药补充剂可能导致了慢性草酸盐中毒，进而导致他的肾衰竭及上述病理表现。肾脏损害被认为是不可逆的，患者返回了尼日利亚。在全球范围内，不受监管的传统草药补充剂使用的增加有可能在农村社区引发肾病流行。对于所有肾功能迅速下降的患者，即使存在已知的慢性肾脏病（CKD）风险因素，也应获取包括使用传统和草药补充剂在内的详尽用药史。
