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Abstract: TH-PO070

Ashwagandha Overdose-Induced AKI: A Novel Case Report

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Natarajan, Hariharasudan, OU Health, Oklahoma City, Oklahoma, United States
  • Maryam, Bibi, OU Health, Oklahoma City, Oklahoma, United States
  • Ahmad, Zahid Bashir, OU Health, Oklahoma City, Oklahoma, United States

Ashwagandha (Withania somnifera) is an Ayurvedic herb with various therapeutic properties, such as anti-inflammatory, antitumor, immunomodulatory, and adaptogenic effects. However, its safety profile is not well established. This abstract highlights the first case of kidney toxicity associated with ashwagandha overdose.

Case Description

A 26-year-old female presented with a 2-day history of progressive abdominal pain, nausea, and vomiting after taking high doses of ashwagandha (6000mg per meal) for a week to treat anxiety. Vital signs were normal, and the physical exam revealed right upper quadrant tenderness. Blood tests showed severe drug-induced liver injury with elevated ALT/AST (>7000 U/L), total bilirubin 2.1 mg/dl, and alkaline phosphatase 82 U/L. Treatment with N-acetyl cysteine improved liver function, but renal function rapidly declined on the second day. Urinalysis showed no hematuria but identified 2+ proteinuria, and a subsequent renal biopsy revealed acute tubular injury. Temporary hemodialysis was required, and the patient eventually recovered with normal kidney function in 2 weeks.


Ashwagandha is known for its potential therapeutic benefits in stress, anxiety, and inflammation. However, the optimal daily dosage remains to be determined. Clinical trials used 300-1000mg/day, while commercial preparations may have higher amounts. A recent in-vitro study suggested that an overdose of the herb's primary metabolite, Withanone, may overwhelm the glutathione detoxifying system and cause DNA damage. Acute tubular injury observed may result from impaired renal tubule protection against oxidative stress. Kidney function returned to normal after discontinuing the medication. Healthcare providers should be vigilant for ashwagandha-related renal toxicities and manage them promptly.