Acute renal failure by ingestion of Euphorbia paralias
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 re...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2013-01-01
|
| Series: | Saudi Journal of Kidney Diseases and Transplantation |
| Online Access: | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2013;volume=24;issue=3;spage=571;epage=575;aulast=Boubaker |
| _version_ | 1818415840336281600 |
|---|---|
| author | Karima Boubaker Mondher Ounissi Nozha Brahmi Rym Goucha Hafedh Hedri Taieb Ben Abdellah Fethi El Younsi Hedi Ben Maiz Adel Kheder |
| author_facet | Karima Boubaker Mondher Ounissi Nozha Brahmi Rym Goucha Hafedh Hedri Taieb Ben Abdellah Fethi El Younsi Hedi Ben Maiz Adel Kheder |
| author_sort | Karima Boubaker |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T11:41:23Z |
| format | Article |
| id | doaj.art-6550033623814232a1d8093185fc66a0 |
| institution | Directory Open Access Journal |
| issn | 1319-2442 |
| language | English |
| last_indexed | 2024-12-14T11:41:23Z |
| publishDate | 2013-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Kidney Diseases and Transplantation |
| spelling | doaj.art-6550033623814232a1d8093185fc66a02022-12-21T23:02:48ZengWolters Kluwer Medknow PublicationsSaudi Journal of Kidney Diseases and Transplantation1319-24422013-01-0124357157510.4103/1319-2442.111069Acute renal failure by ingestion of Euphorbia paraliasKarima BoubakerMondher OunissiNozha BrahmiRym GouchaHafedh HedriTaieb Ben AbdellahFethi El YounsiHedi Ben MaizAdel KhederEuphorbia 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.http://www.sjkdt.org/article.asp?issn=1319-2442;year=2013;volume=24;issue=3;spage=571;epage=575;aulast=Boubaker |
| spellingShingle | Karima Boubaker Mondher Ounissi Nozha Brahmi Rym Goucha Hafedh Hedri Taieb Ben Abdellah Fethi El Younsi Hedi Ben Maiz Adel Kheder Acute renal failure by ingestion of Euphorbia paralias Saudi Journal of Kidney Diseases and Transplantation |
| title | Acute renal failure by ingestion of Euphorbia paralias |
| title_full | Acute renal failure by ingestion of Euphorbia paralias |
| title_fullStr | Acute renal failure by ingestion of Euphorbia paralias |
| title_full_unstemmed | Acute renal failure by ingestion of Euphorbia paralias |
| title_short | Acute renal failure by ingestion of Euphorbia paralias |
| title_sort | acute renal failure by ingestion of euphorbia paralias |
| url | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2013;volume=24;issue=3;spage=571;epage=575;aulast=Boubaker |
| work_keys_str_mv | AT karimaboubaker acuterenalfailurebyingestionofeuphorbiaparalias AT mondherounissi acuterenalfailurebyingestionofeuphorbiaparalias AT nozhabrahmi acuterenalfailurebyingestionofeuphorbiaparalias AT rymgoucha acuterenalfailurebyingestionofeuphorbiaparalias AT hafedhhedri acuterenalfailurebyingestionofeuphorbiaparalias AT taiebbenabdellah acuterenalfailurebyingestionofeuphorbiaparalias AT fethielyounsi acuterenalfailurebyingestionofeuphorbiaparalias AT hedibenmaiz acuterenalfailurebyingestionofeuphorbiaparalias AT adelkheder acuterenalfailurebyingestionofeuphorbiaparalias |