Kidney Week

Abstract: SA-PO049

AKI After Taking the Extract of Cudrania tricuspidata in a Patient Taking Nonsteroidal Anti-Inflammatory Drugs

Session Information

• AKI: Important, Yet Underappreciated Causes
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

• Lee, Sua, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Sua Lee,

• Jun, Jaehyun, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Jaehyun Jun,

• Kim, Jeongwoo, Eulji University College of Medicine, Daejeon, Korea (the Republic of)

Jeongwoo Kim,

Introduction

Acute tubulo-interstitial nephritis (ATIN) is an acute kidney disease characterized by infiltration of inflammatory cells localized in the renal tubules and interstitium. ATIN is well known to be developed by hypersensitivity reaction to drugs or infections. We reported an unusual case of ATIN after taking the extract of Cudrania tricuspidata (C.tricuspidata) with taking long-term nonsteroidal anti-inflammatory drugs (NSAIDs).

Case Description

A 69-year-old male patient visited the emergency room with complaints of general edema that occurred 2 weeks ago and oliguria that occurred 2 days ago. He was diagnosed hypertension 3 years ago. He had been taking Naproxen 500 mg intermittently for knee pain for 6 months and C. trucuspidata leaf tea every day for 3 months. Initial laboratory findings were as follows: blood urea nitrogen, 53 mg/dL; creatinine(Cr), 9.9 mg/dL; estimated glomerular filtration rate(eGFR), 5.3 ml/1.73m²/min; albumin, 3.3g/dL; total immunoglobuin E > 5000 IU/ml; urine protein-creatinine. 14.3 g/mg. He underwent emergent hemodialysis and kidney biopsy to evaluate the cause of acute kidney injury. Light microscopy revealed that numerous lymphoplasmacytic with some eosinophils were infiltrated in the tubulointerstitium, consistent with ATIN. Electron microscopy revealed diffused effacement of foot process and interstitial edema, consistent with minimal change disease(MCD). Steroids were administered intravenously for ATIN and MCD. He was discharged after 4 weeks with Cr 1.5 mg/dL and eGFR 47.1 ml/1.73m²/min.

Discussion

Each case of acute liver failure and acute generalized exanthematous pustulosis after taking the extract of C. trucuspidata was previousely reported. Physicians should be concerned that C. tricuspidata can cause ATIN as a hypersensitivity reaction.

Numerous lymphoplasmacytic with some eosinophils were infiltrated in the tubulointerstitium, consistent with ATIN.