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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In developing countries&#59; traditional&#44; herbal or alternative medicine has huge impacts on patients with chronic diseases&#46; The easy and promised illusion of these products catches attention and drives patients using them&#46; Henna is used traditionally for hair dying and temporary tattooing in Turkey&#44; and many other countries&#59; henna stone also known as German stone is a kind of solid material in which crushed powder form can be used as henna and contains a high amount of <span class="elsevierStyleItalic">p</span>-phenylenediamine &#40;PPD&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Toxicity of this compound has two phases in human&#59; first allergic reaction with angioedema and the second systemic phenomena occurs with intravascular hemolysis&#44; rhabdomyolysis&#44; and acute kidney injury&#46; Herein&#44; we presented a case of an elderly woman who ingests henna stone in the hope of treating diabetes and had acute kidney failure requiring hemodialysis treatment without the initial allergic phase&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 73-year-old woman was brought to the emergency room of Hakkari State Hospital with a one-day history of feeling bad&#44; skeletal muscle pain&#44; dizziness&#44; and disorientation&#46; Two days prior to admission&#44; an herbalist advised her to drink crushed henna stone powder in water for her uncontrolled diabetes and to quit insulins&#46; After she did this&#44; symptoms appeared gradually&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Her examination revealed that she was afebrile&#44; oriented and able to communicate&#46; Her blood pressure was 150&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg with a heart rate of 104<span class="elsevierStyleHsp" style=""></span>bpm&#46; There were no signs of allergic reactions or a shortage of breath with oxygen saturation of 95&#37; in room air&#46; In the investigations&#44; hemoglobin was 10&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; no leukocytosis and a high C-reactive protein level were measured&#46; The other biochemical tests were creatinine kinase 46903<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; AST 719<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; LDH 1315<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; blood glucose 334<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; urea 38&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and creatinine 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Although there was no chest pain &#40;diabetes may hided&#41;&#44; cardiac markers were high&#46; Chest X-ray&#44; electrocardiogram and echocardiography were totally normal&#46; Urine analysis was mildly positive for protein and blood&#46; Renal ultrasound revealed large kidneys with edema&#46; The patient was hospitalized with the diagnosis of rhabdomyolysis&#46; There were no schistocytes in the peripheral smear&#44; serum total and direct bilirubin levels were normal&#44; Coombs tests were negative&#59; detailed serologies including Brucella and Leptospira and other virologic markers were also negative&#44; an upper abdominal ultrasound revealed the only hepatosteatosis&#46; Normoacidemia with limiting bicarbonate level was found in the arterial blood gas analysis&#46; Cardiac markers were decreased in repeated measures&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We started appropriate intravenous fluids with bicarbonate infusion just from the emergency room to alkalinize the urine&#46; At first&#44; she did not have an indication for hemodialysis with normal pH&#44; no electrolyte disturbances or any other clinic situation&#46; But reddish-brown urine and oliguria occurred within 24<span class="elsevierStyleHsp" style=""></span>h&#59; edema and renal failure increased gradually&#46; We started hemodialysis treatment with a femoral catheter on the third day of hospitalization&#46; 24-h proteinuria was 170<span class="elsevierStyleHsp" style=""></span>mg&#47;day and urinary sediment was showed one to two white blood cells&#44; one to three red blood cells&#46; Taken into account the most probable diagnosis of rhabdomyolysis&#44; non-severe proteinuria &#40;below 1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41;&#44; age of patient and harmful side-effects of immunosuppressive treatment&#44; we did not make a renal biopsy or give a corticosteroid&#46; Alterna-day hemodialysis and ultrafiltration provided volume control and after the 7th session of dialysis&#47;ultrafiltration&#44; the patient started to have polyuria&#44; a decrease in CK&#44; LDH and transaminases and also clinical symptoms were relieved&#46; On the 14th day of hospitalization&#44; we withdrew the catheter and she was discharged on 20th day with normal urine output and kidney function&#46; First-month control after discharge&#44; the patient was in a good situation with clinical and laboratory parameters&#46; Initial and follow-up laboratory parameters are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature&#44; there are several case reports about PPD toxicity after topical use or suicide attempt&#46; But toxicity occurring after using as a medicine to a specific disease is lesser&#46; Khine YY was reported a man who drank boiled henna leaves for having an unhealthy feeling and Qurashi et al&#46; notified a 32-year-old male had also boiled henna for dyspepsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> This is the first case using henna or henna leaf as a cure for diabetes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The tirade for PPD intoxication includes exposure to PPD &#40;local or systemic&#41;&#44; early signs of angioneurotic edema and later acute renal failure&#46; A cohort study from Sudan demonstrated that affected patients were more female&#44; of 83&#46;7&#37; were a suicidal attempt and 53&#46;3&#37; had angioneurotic edema&#46; The need for renal replacement therapy as hemodialysis was 86&#46;7&#37;&#44; fortunately&#44; all patients had full recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It should be kept in mind allergic reaction of the upper respiratory system is not a must as seen in our case but life-treating&#46; It may be about the amount of ingested PPD dose&#46; Higher amounts are associated with higher morbidity and mortality rates&#46; The outcome of renal damage is good with early hemodialysis&#46; There is no antidote for PPD&#44; conservative treatment is only the choice in particularly for rhabdomyolysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hemolysis may be a part of the disease and contribute the renal damage&#46; Henna leaf as known <span class="elsevierStyleItalic">Lawsonia alba</span> may induce hemolytic crisis in patients with glucose-6-phosphate dehydrogenase &#40;G6PD&#41; deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Hyperbilirubinemia&#44; increased LDH and reticulocyte count should be listed in the differential diagnosis&#46; In the case&#44; the patient had dark brown urine and normal serum bilirubin levels led us to rhabdomyolysis rather than hemolysis&#46; We do not have a chance to measure the G6PD level after recovery to certainly exclude&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude&#44; refined henna&#47;henna leaf or a henna stone has a wide-spread usage area&#44; and intoxication may occur in a topical or systemic implementation&#46; Physicians should recognize the material&#44; be aware of the lethality and prognosis&#46; Public knowledge about traditional herbal medicine should be risen immediately to decrease this kind of herb-induced acute kidney injury&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">Written informed consent was taken&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Authors declare no conflict of interest&#46;</p></span></span>"
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Letter to the Editor
Acute renal failure due to henna stone ingestion as a remedy of diabetes
Fallo renal agudo debido a la ingestión de cálculos de henna en el tratamiento de la diabetes
Selina Kubata, Hatice Aksua, Nuri Baris Hasbalb,
Corresponding author
nbhasbal@gmail.com

Corresponding author.
a Hakkari State Hospital, Internal Medicine Unit, Turkey
b Hakkari State Hospital, Nephrology Unit, Turkey
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    "titulo" => "Acute renal failure due to henna stone ingestion as a remedy of diabetes"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In developing countries&#59; traditional&#44; herbal or alternative medicine has huge impacts on patients with chronic diseases&#46; The easy and promised illusion of these products catches attention and drives patients using them&#46; Henna is used traditionally for hair dying and temporary tattooing in Turkey&#44; and many other countries&#59; henna stone also known as German stone is a kind of solid material in which crushed powder form can be used as henna and contains a high amount of <span class="elsevierStyleItalic">p</span>-phenylenediamine &#40;PPD&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Toxicity of this compound has two phases in human&#59; first allergic reaction with angioedema and the second systemic phenomena occurs with intravascular hemolysis&#44; rhabdomyolysis&#44; and acute kidney injury&#46; Herein&#44; we presented a case of an elderly woman who ingests henna stone in the hope of treating diabetes and had acute kidney failure requiring hemodialysis treatment without the initial allergic phase&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 73-year-old woman was brought to the emergency room of Hakkari State Hospital with a one-day history of feeling bad&#44; skeletal muscle pain&#44; dizziness&#44; and disorientation&#46; Two days prior to admission&#44; an herbalist advised her to drink crushed henna stone powder in water for her uncontrolled diabetes and to quit insulins&#46; After she did this&#44; symptoms appeared gradually&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Her examination revealed that she was afebrile&#44; oriented and able to communicate&#46; Her blood pressure was 150&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg with a heart rate of 104<span class="elsevierStyleHsp" style=""></span>bpm&#46; There were no signs of allergic reactions or a shortage of breath with oxygen saturation of 95&#37; in room air&#46; In the investigations&#44; hemoglobin was 10&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; no leukocytosis and a high C-reactive protein level were measured&#46; The other biochemical tests were creatinine kinase 46903<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; AST 719<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; LDH 1315<span class="elsevierStyleHsp" style=""></span>IU&#47;L&#44; blood glucose 334<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; urea 38&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and creatinine 0&#46;75<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Although there was no chest pain &#40;diabetes may hided&#41;&#44; cardiac markers were high&#46; Chest X-ray&#44; electrocardiogram and echocardiography were totally normal&#46; Urine analysis was mildly positive for protein and blood&#46; Renal ultrasound revealed large kidneys with edema&#46; The patient was hospitalized with the diagnosis of rhabdomyolysis&#46; There were no schistocytes in the peripheral smear&#44; serum total and direct bilirubin levels were normal&#44; Coombs tests were negative&#59; detailed serologies including Brucella and Leptospira and other virologic markers were also negative&#44; an upper abdominal ultrasound revealed the only hepatosteatosis&#46; Normoacidemia with limiting bicarbonate level was found in the arterial blood gas analysis&#46; Cardiac markers were decreased in repeated measures&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We started appropriate intravenous fluids with bicarbonate infusion just from the emergency room to alkalinize the urine&#46; At first&#44; she did not have an indication for hemodialysis with normal pH&#44; no electrolyte disturbances or any other clinic situation&#46; But reddish-brown urine and oliguria occurred within 24<span class="elsevierStyleHsp" style=""></span>h&#59; edema and renal failure increased gradually&#46; We started hemodialysis treatment with a femoral catheter on the third day of hospitalization&#46; 24-h proteinuria was 170<span class="elsevierStyleHsp" style=""></span>mg&#47;day and urinary sediment was showed one to two white blood cells&#44; one to three red blood cells&#46; Taken into account the most probable diagnosis of rhabdomyolysis&#44; non-severe proteinuria &#40;below 1<span class="elsevierStyleHsp" style=""></span>g&#47;day&#41;&#44; age of patient and harmful side-effects of immunosuppressive treatment&#44; we did not make a renal biopsy or give a corticosteroid&#46; Alterna-day hemodialysis and ultrafiltration provided volume control and after the 7th session of dialysis&#47;ultrafiltration&#44; the patient started to have polyuria&#44; a decrease in CK&#44; LDH and transaminases and also clinical symptoms were relieved&#46; On the 14th day of hospitalization&#44; we withdrew the catheter and she was discharged on 20th day with normal urine output and kidney function&#46; First-month control after discharge&#44; the patient was in a good situation with clinical and laboratory parameters&#46; Initial and follow-up laboratory parameters are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In the literature&#44; there are several case reports about PPD toxicity after topical use or suicide attempt&#46; But toxicity occurring after using as a medicine to a specific disease is lesser&#46; Khine YY was reported a man who drank boiled henna leaves for having an unhealthy feeling and Qurashi et al&#46; notified a 32-year-old male had also boiled henna for dyspepsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> This is the first case using henna or henna leaf as a cure for diabetes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The tirade for PPD intoxication includes exposure to PPD &#40;local or systemic&#41;&#44; early signs of angioneurotic edema and later acute renal failure&#46; A cohort study from Sudan demonstrated that affected patients were more female&#44; of 83&#46;7&#37; were a suicidal attempt and 53&#46;3&#37; had angioneurotic edema&#46; The need for renal replacement therapy as hemodialysis was 86&#46;7&#37;&#44; fortunately&#44; all patients had full recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It should be kept in mind allergic reaction of the upper respiratory system is not a must as seen in our case but life-treating&#46; It may be about the amount of ingested PPD dose&#46; Higher amounts are associated with higher morbidity and mortality rates&#46; The outcome of renal damage is good with early hemodialysis&#46; There is no antidote for PPD&#44; conservative treatment is only the choice in particularly for rhabdomyolysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hemolysis may be a part of the disease and contribute the renal damage&#46; Henna leaf as known <span class="elsevierStyleItalic">Lawsonia alba</span> may induce hemolytic crisis in patients with glucose-6-phosphate dehydrogenase &#40;G6PD&#41; deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Hyperbilirubinemia&#44; increased LDH and reticulocyte count should be listed in the differential diagnosis&#46; In the case&#44; the patient had dark brown urine and normal serum bilirubin levels led us to rhabdomyolysis rather than hemolysis&#46; We do not have a chance to measure the G6PD level after recovery to certainly exclude&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude&#44; refined henna&#47;henna leaf or a henna stone has a wide-spread usage area&#44; and intoxication may occur in a topical or systemic implementation&#46; Physicians should recognize the material&#44; be aware of the lethality and prognosis&#46; Public knowledge about traditional herbal medicine should be risen immediately to decrease this kind of herb-induced acute kidney injury&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">Written informed consent was taken&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Authors declare no conflict of interest&#46;</p></span></span>"
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Article information
ISSN: 20132514
Original language: English
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