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Successful Resolution of Suspected Red Yeast Rice-induced Nephropathy.

Haruka Maruyama1, Ken-Ei Sada2, Machiko Oka1

  • 1Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan.

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Summary

Red yeast rice supplements contaminated with puberulic acid caused kidney injury, including Fanconi syndrome and interstitial nephritis, in Japanese patients. One patient recovered renal function after stopping the supplement, highlighting the importance of biopsy findings in guiding treatment decisions.

Keywords:
Fanconi syndromeinterstitial nephritisred yeast ricerenal failuresupplement

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Area of Science:

  • Nephrology
  • Toxicology
  • Integrative Medicine

Background:

  • Several Japanese patients developed interstitial nephritis or acute tubular injury/necrosis with Fanconi syndrome after consuming a red yeast rice supplement.
  • Renal function often did not recover fully, even with treatment discontinuation and glucocorticoids.

Purpose of the Study:

  • To report a case of interstitial nephritis and Fanconi syndrome following red yeast rice supplement consumption.
  • To investigate the clinical course and treatment response guided by renal biopsy findings.

Main Methods:

  • A 52-year-old woman presented with interstitial nephritis and Fanconi syndrome after supplement intake.
  • Renal biopsy showed mild lymphocytic infiltration.
  • Treatment involved discontinuing the supplement without glucocorticoids.

Main Results:

  • The patient's renal function recovered after discontinuing the supplement.
  • The supplement was found to be contaminated with puberulic acid, a known nephrotoxin.
  • The specific cause of interstitial nephritis remained undetermined, but biopsy guided conservative management.

Conclusions:

  • Red yeast rice supplements can cause severe kidney injury, including Fanconi syndrome and interstitial nephritis.
  • Renal biopsy findings are crucial for guiding appropriate treatment strategies.
  • Avoiding unnecessary glucocorticoid treatment, based on biopsy, may aid recovery.