Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Acute renal tubular necrosis due to grass carp ingestion in a myeloma patient after allogeneic stem cell transplantation

Bone Marrow Transplantation volume 33, pages 669–670 (2004)Cite this article

Acute renal dysfunction is a life-threatening complication after allogeneic stem cell transplantation (SCT). Drug-induced nephrotoxicity, due to cyclosporin, amphotericin B, aminoglyosides, vancomycin, cidofovir and foscarnet, is usually reversible with dose reduction or withdrawal.1 Other disease or treatment-related systemic conditions may also contribute to early or late acute and chronic renal compromise.2,3 These included diabetes, myeloma kidney, hemolysis, tumor lysis syndrome, viral nephritis and cystitis and sepsis-related multiorgan failure. For most cases, renal biopsy is not necessary for diagnosis. Since SCT recipients usually follow a strict diet prescription, renal failure due to food toxicity is uncommon.

Grass carp (Ctenopharyngodon idella) nephrotoxicity is a well documented, but rare cause of food poisoning in Asia and North America.4,5 A thermostable nephrotoxin is concentrated in the gall bladder and originates from the specific algae diet of the carp species.6 All cases are heralded by symptoms of food poisoning, and renal impairment is preceded by hepatitis in one-third of patients. Acute tubular necrosis and nonoligouric azotaemia is the classical presentation. Despite dialysis, patients often make a complete recovery. The risk of intoxication is reduced by thorough cooking and by discarding the fish gall bladder, and new cases have not been reported in Hong Kong for decades. Such poisoning has never been reported in transplant recipients and our case raised several interesting issues. Although the amount of residual toxin ingested by our patient was probably small, the gut damage associated with SCT conditioning and stem cell infusion may facilitate trans-mural passage of toxin. Furthermore, age, myeloma and CsA usage may all predispose to tubular toxicity. Despite the alarming clinical presentation and complicated medical background, a prompt renal biopsy and detailed history taking pinpointed the diagnosis in our case. Allogeneic SCT and other organ transplants are increasingly performed in Asian developing countries, where fresh water fish form a staple part of protein diet and may even have health promotion connotations.4,5 Since most SCT recipients receive meticulous diet instructions, such diet cautions should be made known to patients of the appropriate racial and geographical background. Finally, the successful use of rapamycin to tie over immunosuppression suggests its possible role as an alternative to CsA or tacrolimus in the presence of renal contraindications.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Herget-Rosenthal S, Uppenkamp M, Beelen D et al. Renal complications of high-dose chemotherapy and peripheral blood stem cell transplantation. Nephron 2000; 84: 136–141.

    Article  CAS  Google Scholar 

  2. Pulla B, Barri YM, Anaissie E . Acute renal failure following bone marrow transplantation. Ren Fail 1998; 20: 421–435.

    Article  CAS  Google Scholar 

  3. Cohen EP, Piering WF, Kabler-Babbitt C, Moulder JE . End-stage renal disease (ESRD) after bone marrow transplantation: poor survival compared to other causes of ESRD. Nephron 1998; 79: 408–412.

    Article  CAS  Google Scholar 

  4. [No authors listed]. Acute hepatitis and renal failure following ingestion of raw carp gallbladders – Maryland and Pennsylvania, 1991 and 1994. MMWR Morb Mortal Wkly Rep 1995; 44: 565–566.

  5. Sahoo RN, Mohapatra MK, Sahoo B, Das GC . Acute renal failure associated with freshwater fish toxin. Trop Geogr Med 1995; 47: 94–95.

    CAS  PubMed  Google Scholar 

  6. Park SK, Kim DG, Kang SK et al. Toxic acute renal failure and hepatitis after ingestion of raw carp bile. Nephron 1990; 56: 188–193.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong

    M F Lam, K C Tse & W Y Au

  2. Department of Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong

    K W Chan

Authors
  1. M F Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K C Tse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K W Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W Y Au
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lam, M., Tse, K., Chan, K. et al. Acute renal tubular necrosis due to grass carp ingestion in a myeloma patient after allogeneic stem cell transplantation. Bone Marrow Transplant 33, 669–670 (2004). https://doi.org/10.1038/sj.bmt.1704403

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704403

Search

Advanced search

Quick links