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[Clinical characteristics and long-term follow-up analysis of three cases with newborn aristolochic acid nephropathy]. | LitMetric

[Clinical characteristics and long-term follow-up analysis of three cases with newborn aristolochic acid nephropathy].

Zhonghua Er Ke Za Zhi

Department of Pediatrics, Chinese Academy of Medical Sciences, Beijing, China.

Published: November 2011

AI Article Synopsis

  • The study analyzes three newborns who experienced acute renal failure due to consuming Chinese herbal medicines with akebia trifoliate, showing symptoms like vomiting and diarrhea.
  • Lab tests revealed serious kidney injury, with indications of electrolyte imbalances and metabolic acidosis, but after 3-4 weeks of treatment, their renal function improved significantly.
  • Long-term follow-up showed that while most infants had normal kidney function initially, two cases later showed increased serum creatinine levels and decreased eGFR, indicating potential lingering kidney issues.

Article Abstract

Objective: To summarize the clinical characteristics and prognosis of newborn aristolochic acid nephropathy induced by akebia.

Method: Retrospective analysis of clinical manifestations, therapy and prognosis was made upon data of 3 newborn infants with renal function lesion induced by akebia.

Result: Three infants who were fed with Chinese herbal medicines containing akebia trifoliate suffered from acute renal failure, renal glomerular and tubular injury, with symptoms of vomiting, diarrhea, and oliguria. Laboratory tests manifested hyperpotassemia, hyponatremia, elevation of serum creatinine and urea nitrogen, and metabolic acidosis. Renal glomerular lesion was mild, presented with proteinuria and increased serum β(2) microglobin. Renal dysfunction was manifested with alkaline urine, glucosuria, positiveness of urine glucose, ketone and aminoaciduria, and increased urine β(2) microglobin excretion. After symptomatic treatment for 3 to 4 weeks, the renal function of these infants recovered. Proteinuria, aminoaciduria and glucosuria turned negative within 5 to 8 months, 3 months to 1 year, and 9 months to 3 years, respectively. Urine pH decreased to 7.0 after 5.0 - 5.5 years. All cases took citric acid mixtures for 5.5 to 6 years. A 12-years follow-up demonstrated that serum creatinine of 3 cases were within normal range during the first 11 years of life, however recent follow-up showed increased serum creatinine of case 1 and case 2, except for serum creatinine of case 3 remained normal. The estimated glomerular filtration rate (eGFR) of all the 3 cases decreased. Among which, eGFR of case 1 and case 2 were lower than 90 [ml/(min·1.73 m(2))], and decreased 1.1 [ml/(min·1.73 m(2))] and 0.6 [ml/(min·1.73 m(2))] per year during recent six years, respectively. No obvious decrease of eGFR was observed in case 3. Blood gas analysis and urine routine were normal, yet blood and urine β(2) microglobin excretion were still high. Urinary N-acetyl-β-D-glucosaminidase increased again after having returned to normal.

Conclusion: Newborn aristolochic acid nephropathy induced by akebia might induce acute renal failure and renal tubules injury. Renal function could recover after symptomatic treatment in short-term. Nevertheless, glomerular filtration rate presents a slow descending tendency and renal tubules lesion lasted for many years, which requires a long-term follow-up.

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