title: Renal failure in a soldier taking N.O.-Xplode.
abstract: BACKGROUND
  Dietary supplements are widely used but are unregulated by the US Food and Drug Administration. Presented here is a case of severe renal failure possibly associated with a dietary supplement, which demonstrates the need for improved patient-physician communication regarding the possible risks and lack of regulation of dietary supplements.
  
  
  METHODS
  A 26-year-old man presented with 3 days of flank pain. The patient had been taking a dietary supplement called N.O.-Xplode for 3 months. Initial laboratory tests revealed a creatinine value of 9.45 mg/dL. Extensive laboratory analysis and imaging revealed no underlying cause of his renal injury. Renal biopsy showed acute tubular necrosis with normal glomeruli. After discontinuing N.O.-Xplode, renal function returned to normal within 1 week.
  
  
  CONCLUSIONS
  This case demonstrates the need for improved patient-physician communication about dietary supplements. The patient had not consulted a physician before initiating use; the amount of each ingredient contained in the dietary supplement is unavailable; and there are no available data regarding safety or efficacy. It is critical that physicians are able and open to counseling patients on the inherent risks associated with dietary supplements, including their lack of regulation by the Food and Drug Administration, unknown efficacy, and possible serious adverse outcomes.
authors.affiliation: From the Department of Family Medicine, Tripler Army Medical Center, Honolulu, HI. ksiano1@gmail.com.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Siano
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000596:Amino Acids / Q000009:adverse effects*; D002110:Caffeine / Q000009:adverse effects*; D003401:Creatine / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects; D005492:Folic Acid / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000009:adverse effects*; D014280:Triglycerides / Q000009:adverse effects*; D014805:Vitamin B 12 / Q000009:adverse effects*; D025101:Vitamin B 6 / Q000009:adverse effects*
chemical_list: D000596:Amino Acids; C000596989:N.O.-Xplode; D014280:Triglycerides; D009569:Nitric Oxide; D002110:Caffeine; D025101:Vitamin B 6; D005492:Folic Acid; D003401:Creatine; D014805:Vitamin B 12
keywords: Case Reports; Dietary Supplements; Kidneys; Renal Failure