Acute Kidney Injury Associated With Boswellia serrata for Radiation Necrosis

Boswellia serrata is a herbal natural health product derived from the B serrata tree. Although not approved by regulatory agencies, it possesses anti-inflammatory properties and is used for inflammatory bowel disease, osteoarthritis, and rheumatoid arthritis. Radiation necrosis is a complication of cranial radiation therapy characterized by cellular injury to the vascular endothelium and cerebral white matter. Acute kidney injury as an adverse effect of B. serrata has not been reported previously. We reported a 72-year-old female who developed acute kidney injury after taking B. serrata capsules for 8 days to manage radiation necrosis. Her symptoms resolved upon discontinuation of B. serrata and presentation to the emergency department for treatment. In summary, B. serrata may potentially cause acute kidney injury when taken at high doses and underscores the need for careful supervision.