Acute renal failure by ingestion of Euphorbia paralias

Abstract

Euphorbia paralias is known in traditional medicine as an anti-inflammatory agent, a purgative and for its local anesthetic property. To the best our knowledge, renal toxicity of this substance has not been previously reported. In this paper, we report the case of a 29-year-old male who developed renal damage following ingestion of Euphorbia paralias. He had been on follow-up for nephrotic syndrome since 1986, although irregularly, with several relapses but each responding well to steroid therapy. A kidney biopsy had not been performed earlier due to refusal by the patient. He was off steroids since April 2008 because the patient developed osteoporosis. He was admitted with general malaise and oliguria to our department in May 2009, following repeated vomiting and watery diarrhea for three days. On examination, he was edematous but had normal vital signs except for a pulse rate of 120/min. Hemoglobin was only 5.5 g/dL but with normal white cell and platelet counts. Blood biochemistry showed evidence of advanced renal failure with a serum creatinine level of 1835 μmol/L and urea at 44.6 mmol/L, sodium of 132 μmol/L and potassium at 4.3 mmol/L. He had features of nephrotic syndrome with severe hypoproteinamia and 24-h urinary protein of 10.45 g. Ultrasonography revealed enlarged kidneys with a reduced echogenecity of the medulla and the papillae. Subsequently, after hemodialysis with blood transfusion, a kidney biopsy was performed that showed focal segmental glomerulosclerosis associated with an acute tubular injury. On intensive interrogation, the patient gave a history of ingesting boiled Euphorbia paralias as a native treatment for edema, ten days prior to the onset of the current illness. A diagnosis of acute renal failure (ARF) resulting from the possible nephrotoxic effect of Euphorbia paralias poisoning was made. He was treated with intermittent hemodialysis and corticosteroids. Serum creatinine values improved after 48 days. At six months following the intoxication, serum creatinine of the patient was 240 μmol/L. In cases of unexplained ARF, a toxic mechanism should always be considered and acute renal failure caused by Euphorbia paralias should be included as a cause if renal toxicity is suspected in those places where it is being used as a native medicine.

Nephrotoxicity and Chinese Herbal Medicine

“…In many patients, the exact pathology associated with AKI is not well understood, but in others, a diagnosis has been made on the basis of kidney biopsy or other clinical observations that substantiate a clear mechanism of injury. In several patients, the most common causes of AKI were acute tubular necrosis and acute interstitial nephritis (11)(12)(13)(14). Several representative patients are discussed.…”

Adverse effects of medicinal herbs on the human kidney

“…As illustrated in Figure 1, we only found five publications which matched our inclusion criteria in our electronic search initially, and all of them were case reports [29][30][31][32][33] . Furthermore, we have gathered other five publications through the reviews [34][35][36][37][38] and another case report 39 has been manually selected.…”

“…Toxic raise of calcineurin inhibitor levels in transplanted renal patients Pomelo (Citrus maxima) 35 Noni juice (Morinda citrifolia) 34 iii. Hydroelectrolytic disorder in a chronic kidney disease patient Sea spurge (Euphorbia paralias) 29 iv. Acute renal failure in patients with a history of renal disease As illustrated in Figure 2, most of case reports fall into category i.…”

Renal Diseases and Use of Medicinal Herbal Extracts: A Concise Update of Reported Literature in Africa

“…The AKI was due to a severe tubular necrosis. However, the exact mechanism of the toxicity is not known [31].…”