Matsui-Hosoya Reina, Sato Koji, Yagasaki Motohiro, Hirose Hitomi, Fukao Yusuke, Kano Toshiki, Io Hiroaki, Suzuki Yusuke
Department of Nephrology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
Department of Nephrology, Faculty of Medicine, Juntendo University, 3-1-3 Hongou, Bunkyo-ku, Tokyo, 133-8431, Japan.
CEN Case Rep. 2025 Jun;14(3):468-476. doi: 10.1007/s13730-024-00955-2. Epub 2024 Dec 11.
To date, the treatment strategy and long-term prognosis of acute kidney injury (AKI) after taking Benikoji CholesteHelp, a red yeast rice supplement, remains unclear. We present three cases wherein renal dysfunction improved within a few months of supplement discontinuation, without immunosuppressive therapy. Case 1: A 59-year-old woman with a history of hypertension, treated with telmisartan (serum creatinine [sCr]: 0.65 mg/dL; estimated glomerular filtration rate [eGFR]: 71.3 mL/min/1.73 m) and Benikoji CholesteHelp for 7 months, developed Fanconi syndrome (FS) and severe renal impairment (sCr: 2.32 mg/dL; eGFR: 17.7 mL/min/1.73 m). Renal biopsy and gallium-67 scintigraphy revealed no active drug-induced interstitial nephritis. Her condition improved significantly after supplement discontinuation. Her renal function gradually improved, with 3-month follow-up sCr and eGFR values of 0.96 mg/dL and 46.5 mL/min/1.73 m, respectively; however, these were still worse than the pre-onset values. Case 2: A 48-year-old man had mild renal dysfunction (sCr: 1.12 mg/dL; eGFR: 56.76 mL/min/1.73 m) after taking Benikoji CholesteHelp for approximately 2 years; this was reversed upon supplement discontinuation. Case 3: A 47-year-old man with FS and mild renal dysfunction (sCr: 1.09 mg/dL; eGFR: 58.5 mL/min/1.73 m) after taking Benikoji CholesteHelp for approximately 4 months, showed notable improvement in FS after supplement discontinuation; however, the mild renal dysfunction persisted. The primary intervention in all cases was immediate supplement discontinuation, leading to rapid improvement in renal function, without need for immunosuppressive therapy. These findings increase our understanding of renal impairment caused by red yeast rice, with improvement after withdrawal, sometimes after several months.
迄今为止，服用红曲补充剂贝尼科吉胆益康（Benikoji CholesteHelp）后急性肾损伤（AKI）的治疗策略和长期预后仍不明确。我们报告三例病例，在停用补充剂后数月内肾功能得到改善，且未进行免疫抑制治疗。病例1：一名59岁女性，有高血压病史，服用替米沙坦（血清肌酐[sCr]：0.65mg/dL；估计肾小球滤过率[eGFR]：71.3mL/min/1.73m²）和贝尼科吉胆益康7个月，出现范科尼综合征（FS）和严重肾功能损害（sCr：2.32mg/dL；eGFR：17.7mL/min/1.73m²）。肾活检和镓-67闪烁扫描未发现活动性药物性间质性肾炎。停用补充剂后她的病情显著改善。她的肾功能逐渐改善，3个月随访时sCr和eGFR值分别为0.96mg/dL和46.5mL/min/1.73m²；然而，这些值仍比发病前差。病例2：一名48岁男性在服用贝尼科吉胆益康约2年后出现轻度肾功能不全（sCr：1.12mg/dL；eGFR：56.76mL/min/1.73m²）；停用补充剂后肾功能恢复正常。病例3：一名47岁男性在服用贝尼科吉胆益康约4个月后出现FS和轻度肾功能不全（sCr：1.09mg/dL；eGFR：58.5mL/min/1.73m²），停用补充剂后FS有显著改善；然而，轻度肾功能不全仍然存在。所有病例的主要干预措施是立即停用补充剂，肾功能迅速改善，无需免疫抑制治疗。这些发现增进了我们对红曲所致肾功能损害的理解，停药后有时数月后肾功能会改善。
