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Abstract: A 36-year-old male with no previous history of renal disease presented with diarrhea and vomiting after an unclean diet, no decreased urine output, no fever, no carnitic hematuria, and elevated blood creatinine. After admission to the hospital, he was considered to have acute interstitial nephritis caused by allergy after excavation of medical history and perfect examination. After giving standardized drug treatment, the patient’s spirit improved significantly, appetite improved, and renal function and all indexes returned to normal.
Basic information】Male, 36 years old
Disease Type】Acute interstitial nephritis
Hospital】Jiangsu Provincial Hospital of Traditional Chinese Medicine
Date of Consultation】April 2022
Treatment plan】Medication (Prednisone acetate tablets, Ziling mycelium capsules)
Treatment Period】14 days in hospital
Effectiveness】Renal function returned to normal
I. Initial consultation
The patient, a young male, developed nausea and vomiting after eating local specialties on a trip abroad, had diarrhea for 2 days, no fever, no hypotension, no decrease in urine output, accompanied by weakness and poor appetite, and was examined on April 20 with a blood creatinine of 124.3umol/L and a hemoglobin of 167g/L. He was reexamined on April 25 with a blood creatinine of 141umol/L. He was admitted to our department for further treatment. The patient reported that he had no previous history of kidney disease, but after gastroenteritis, he found a sharp increase in blood creatinine. The preliminary diagnosis was renal insufficiency and the possibility of acute renal failure.
II. Treatment history
After admission to the hospital, the patient again pursued the medical history. The patient reported that the food he ate was special, a local specialty, but after eating, he had obvious abdominal discomfort, followed by vomiting and diarrhea, and was accompanied by a pinpoint rash on both sides of the waist, no lower limb rash, along with gastrointestinal symptoms such as weakness and poor appetite. We explained the patient’s condition and considered that there were dietary triggers for the disease, and considered non-oliguric acute renal insufficiency due to the rash and elevated blood creatinine, and actively improved the examination to find the cause of renal insufficiency. Prednisone tablets and mycelium capsules were administered orally daily.
Treatment effect
After 3 days of drug treatment, the patient’s mental status improved significantly and his appetite was improved, with no recurrence of diarrhea or vomiting. After 14 days of treatment, his renal function and blood creatinine gradually decreased to normal, blood eosinophils returned to normal, gastrointestinal symptoms improved significantly, and renal function basically returned to normal, so the patient was discharged from the hospital.
IV. Notes
We are glad that the patient’s condition is under control, but we still need to advise the patient to continue to monitor renal function and electrolytes after discharge, as some acute kidney injury can return to normal after removing factors, but renal damage may still occur, such as proteinuria, hematuria, etc., and transform into chronic kidney disease, while the application of hormones and adjustment of dose need to follow medical advice.
Moreover, it is necessary to avoid contact with some suspected allergens such as drugs, food and environmental factors as much as possible in life, so that kidney damage will not be further aggravated only if repeated allergies are prevented.
V. Personal insight
The patient has a sudden increase in blood creatinine and no previous history of kidney disease, so renal insufficiency is generally considered, and acute renal failure is highly considered, and the causes need to be examined as soon as possible and removed so that renal function can be reversed, reducing the duration of the disease and the possibility of turning into chronic kidney disease. At the same time to this case patients want to prevent acute interstitial nephritis further cause kidney injury occurred, it is important to use reasonable medication under the guidance of a doctor, not blindly use drugs, especially herbal remedies, etc., while avoiding contact with allergic drugs and food, so as to effectively prevent the recurrence of the disease.