title: An unusual cause of hypokalemic paralysis: aristolochic acid nephropathy with Fanconi syndrome.
abstract: Aristolochic acid nephropathy (AAN) with Fanconi syndrome presenting as hypokalemic paralysis is extraordinarily rare and may be unrecognized. We describe a 41-year-old man who presented with the inability to ambulate upon awakening in the morning. Physical examination revealed symmetric paralysis of bilateral lower limbs. Laboratory studies showed profound hypokalemia with renal potassium (K) wasting, hyperchloremic metabolic acidosis, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, and glycosuria, consistent with Fanconi syndrome. Mild renal insufficiency was also observed. A meticulous search for underlying causes of Fanconi syndrome was unrevealing. However, a significant amount of aristolochic acid (AA) was detected in the consumed Chinese herb mixture (AA-I, 7 microg/g) for the treatment of his leg edema for the past 2 months. His hypokalemia, renal insufficiency, and Fanconi syndrome completely resolved 2 months after the withdrawal of Chinese herb mixture and the supplementation of potassium citrate and active vitamin D3. AAN with Fanconi syndrome should be considered as a cause of hypokalemia in any patient administered undefined Chinese herbs.
authors.affiliation: Division of Nephrology, Department of Medicine, Macky Memorial Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Tsai
authors.forename: Yi-Chou
authors.initials: YC
authors.lastname: Chen
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Cheng
authors.forename: Shih-Hua
authors.initials: SH
authors.lastname: Lin
mesh_terms: D000328:Adult; D034341:Aristolochic Acids / Q000009:adverse effects* / Q000627:therapeutic use; D005198:Fanconi Syndrome / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000139:chemically induced* / Q000150:complications / Q000473:pathology*; D008297:Male; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*
chemical_list: D034341:Aristolochic Acids; C000228:aristolochic acid I