Multiorgan failure caused by Chinese herbal medicine Xanthii Fructus poisoning: a case report

BACKGROUND

Xanthii Fructus was used in the treatment of rhinitis and related nasal disease. It is the most commonly used chemically active component in compounds formulated for the treatment of rhinitis. However, poisoning, resulting in serious consequences, can easily occur owing to cocklebur overdose, improper processing, or usage without processing.

CASE PRESENTATION

We reported on a 55-year-old man who experienced allergic rhinitis for 2.5 years. He ingested unprocessed Xanthii Fructus for 2 months as treatment. However, he developed anorexia; nausea; abdominal pain; general weakness; hiccups; oliguria and anuria; significantly elevated serum alanine aminotransferase, aspartate aminotransferase, and creatinine levels; and abnormalities in blood coagulation series. Nutritional support; daily drugs for liver protection, gastric protection, inflammation reduction; fresh plasma; and cryoprecipitate infusion were administered. Continuous venovenous hemodialysis (Prismaflex ST100) was also administered. However, the patient's multiple organ failure gradually worsened, ultimately leading to death.

CONCLUSION

Xanthii Fructus poisoning affects multiple systems, and its clinical manifestations are complex. Therefore, it is easily misdiagnosed and missed. Along with careful inquiry of medical and medication history, early diagnosis and intervention are vital for a successful treatment. It is also important to educate people and create awareness about this poisoning. Therefore, this intractable case has great clinical significance.

Urinary cadmium and peripheral blood telomere length predict the risk of renal function impairment: a study of 547 community residents of Shanxi, China

Few reports have investigated the predictive value of urinary cadmium (UCd) and telomere length on renal function impairment. Therefore, we constructed nomogram models, using a cross-sectional survey to analyze the potential function of UCd and telomere length in renal function impairment risk. We randomly selected two community populations in Shanxi, China, and general information of the subjects was collected through face-to-face questionnaire surveys. Venous blood of subjects was collected to detect absolute telomere length (ATL) by real-time quantitative chain reaction (RT-PCR). Collecting urinary samples detected UCd and urinary N-acetyl-β-d-glucosaminidase (UNAG). Estimated glomerular filtration rate (eGFR) was obtained based on serum creatinine (SCr). Nomogram models on risk prediction analysis of renal function impairment was constructed. After adjusting for other confounding factors, UCd (β = 0.853, 95% confidence interval (CI): 0.739 ~ 0.986) and ATL (β = 1.803, 95%CI: 1.017 ~ 1.154) were independent risk influencing factors for increased UNAG levels, and the risk factors for eGFR reduction were UCd (β = 1.011, 95%CI: 1.187 ~ 1.471), age (β = 1.630, 95%CI: 1.303 ~ 2.038), and sex (β = 0.181, 95%CI: 0.105 ~ 0.310). Using UCd, ATL, sex, and age to construct the nomogram, and the C-statistics 0.584 (95%CI: 0.536 ~ 0.632) and 0.816 (95%CI: 0.781 ~ 0.851) were obtained by internal verification of the calibration curve, C-statistics revealed nomogram model validation was good and using decision curve analysis (DCA) confirmed a good predictive value of the nomogram models. In a nomogram model, ATL, UCd, sex, and age were detected as independent risk factors for renal function impairment, with UCd being the strongest predictor.

Atorvastatin calcium tablets on inflammatory factors, hemorheology and renal function damage indexes in patients with diabetic nephropathy

Objectives:

To investigate the effect of atorvastatin on inflammatory factors, hemorheology, and renal function damage in patients with diabetic nephropathy (DN).

Methods:

One hundred and six DN patients who were treated in our hospital between June 2018 and August 2019 were selected and randomly grouped into observation group and control group, 53 each group. Patients in the control group were given the conventional treatment; patients in the observation group were given atorvastatin treatment on the basis of the conventional treatment. They were treated for three months. The hemorheology indexes (whole blood viscosity, erythrocyte aggregation index, and fibrinogen (FIB)), renal function damage indexes (macrophage migration inhibitory factor (MIF), vascular cell adhesion molecule (VCAM)-1, Secreted frizzled-related protein-5 (SFRP5), and mAIb/Cr) and inflammatory factor related indexes (C-reactive protein (CRP), interleukin-1 (IL-1), and tumor necrosis factor-α (TNF-α)) were compared between the two groups before and after three months of treatment.

Results:

After three months of treatment, the hemorheology indexes, renal function damage indexes, and inflammatory factors related indexes in the two groups changed. Compared with the control group, the whole blood viscosity, erythrocyte aggregation index, FIB, MIF, VACM-1, mAIb/Cr, CRP, IL-1, and TNF-α levels in the observation group significantly decreased, while the levels of SERP-5 significantly increased; the differences were statistically significant (P<0.05).

Conclusion:

Atorvastatin can effectively alleviate the renal function damage in patients with DN, reduce the level of serum inflammatory factors, and improve hemorheology, which has a good clinical application value for DN patients.