title: Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract.
abstract: BACKGROUND
  Alternative medical therapies are increasingly being prescribed due to their good safety profile and perceived limited side effects. They are often unregulated and prescribed over the counter. One such medication is horse chestnut seed extract (HCSE), which is used for the treatment of chronic venous insufficiency and is known to affect blood coagulation. Angiomyolipoma (AML) is a benign fat-containing mesenchymal tumor of the kidney. It is often found incidentally and in most cases can be managed conservatively. Rupture of the kidney with hemorrhage is a well-known complication that may be serious and life-threatening. Known risk factors for hemorrhage include anticoagulation as well as pregnancy, increased size of the lesion, high lesion vascularity, and aneurysm formation within the tumor.
  
  
  OBJECTIVE
  The aim is to raise awareness of potential HCSE-induced anticoagulation, including, as in the case presented, acute renal AML hemorrhage.
  
  
  METHODS
  The case of a patient taking HCSE for venous insufficiency is presented. The patient suffered a life-threatening rupture of the kidney in the presence of known renal AML. She underwent emergency embolization with a successful outcome. Because HCSE-containing products are thought to be generally safe in the treatment of chronic venous insufficiency, it is important to be mindful of their potential anticoagulant properties and, therefore, their relative contraindication both in patients taking other anticoagulants and those with known renal AML.
  
  
  CONCLUSIONS
  We demonstrate a potentially life-threatening association between HSCE-containing products and renal AML, highlighting the risk associated with HSCE-induced anticoagulation.
authors.affiliation: Department of Radiology, Adelaide & Meath Hospital, Dublin, Ireland.
authors.forename: Aisling
authors.initials: A
authors.lastname: Snow
authors.forename: Darragh
authors.initials: D
authors.lastname: Halpenny
authors.forename: Graeme
authors.initials: G
authors.lastname: McNeill
authors.forename: William C
authors.initials: WC
authors.lastname: Torreggiani
mesh_terms: D031319:Aesculus / Q000009:adverse effects*; D018207:Angiomyolipoma / Q000150:complications*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications*; D008875:Middle Aged; D008517:Phytotherapy; D010936:Plant Extracts / Q000009:adverse effects* / Q000627:therapeutic use; D012422:Rupture, Spontaneous / Q000139:chemically induced; D012639:Seeds / Q000737:chemistry*; D014689:Venous Insufficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D010936:Plant Extracts