title: Aristolochic acid-induced Fanconi's syndrome and nephropathy presenting as hypokalemic paralysis.
abstract: Hypokalemic paralysis rarely is seen as the presenting feature in patients with Fanconi's syndrome. We describe a 60-year-old man who presented with the inability to ambulate on awakening in the morning. The pertinent history revealed he had consumed Chinese herbs for leg edema for 5 months. Physical examination was unremarkable except for extracellular fluid volume depletion and total paralysis of both lower extremities. Laboratory investigation showed hypokalemia (1.8 mEq/L), hyperchloremic metabolic acidosis (Cl-, 111 mEq/L, and HCO3-, 14.0 mEq/L), hypophosphatemia (0.9 mg/dL) with hyperphosphaturia, hypouricemia (1.3 mg/dL) with hyperuricosuria, and glycosuria, consistent with Fanconi's syndrome. Mild renal insufficiency (serum creatinine, 1.7 mg/dL) also was noticed. Blood and urine screens for heavy metals, autoantibodies, and monoclonal gammopathy were negative. A renal biopsy specimen revealed typical findings of aristolochic acid-associated nephropathy. Aristolochic acids were detected in the consumed Chinese herbs. This case highlights that consumption of Chinese herbs containing aristolochic acids may cause Fanconi's syndrome and should be considered as a cause of hypokalemic paralysis.
authors.affiliation: Division of Nephrology, Department of Medicine, and Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Sung-Sen
authors.initials: SS
authors.lastname: Yang
authors.forename: Pauling
authors.initials: P
authors.lastname: Chu
authors.forename: Yuh-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: An
authors.initials: A
authors.lastname: Chen
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005198:Fanconi Syndrome / Q000139:chemically induced*; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000150:complications; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000139:chemically induced*; D010616:Phenanthrenes / Q000009:adverse effects*
chemical_list: D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal; D010616:Phenanthrenes; C000228:aristolochic acid I