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.