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Lead poisoning from an Ayurvedic herbal medicine in a patient with chronic kidney disease

Nature Reviews Nephrology volume 5, pages 297–300 (2009)Cite this article

Abstract

Background. A 60-year-old man with a history of diabetes and hypertension was referred to a nephrology clinic for investigation of his elevated serum creatinine level.

Investigations. Physical examination; laboratory investigations, including measurement of whole-blood lead level, body lead burden and urine albumin:creatinine ratio; history of lead exposure and use of herbal medical products; and renal ultrasonography.

Diagnosis. Stage 3 chronic kidney disease that was probably worsened by consumption of lead in the form of an Ayurvedic herbal remedy.

Management. Cessation of the herbal product, followed by lead-chelation therapy with calcium disodium ethylenediaminetetraacetic acid. The patient's whole-body lead burden and blood lead level decreased to acceptable levels and his serum creatinine value was within the normal range at final follow-up.

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Figure 1: Changes in levels of serum creatinine, blood lead, and body lead burden in the patient over time.
Figure 2: Changes over time in serum creatinine level, hemoglobin values and dose of angiotensin-converting-enzyme inhibitor in the patient described.

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Acknowledgements

The authors wish to thank Dr Joanne Bargman for her assistance. G. T. Hernandez is supported by grants from the Paso del Norte Health Foundation, Texas Tech University Health Sciences Center, and the Manuel & Guadalupe Soto Memorial Research Fund. V. Bhalla is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Kidney Foundation.

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Suma Prakash

  2. Division of Nephrology & Hypertension, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA

    German T. Hernandez

  3. San Francisco Department of Public Health, San Francisco, CA, USA

    Ihsan Dujaili

  4. Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA

    Vivek Bhalla

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  1. Suma Prakash
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Correspondence to Suma Prakash.

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Prakash, S., Hernandez, G., Dujaili, I. et al. Lead poisoning from an Ayurvedic herbal medicine in a patient with chronic kidney disease. Nat Rev Nephrol 5, 297–300 (2009). https://doi.org/10.1038/nrneph.2009.41

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