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Bnaya A, Abu-Amer N, Beckerman P, Volkov A, Cohen-Hagai K, Greenberg M, Ben-Chetrit S, Ben Tikva Kagan K, Goldman S, Navarro HA, Sneineh MA, Rozen-Zvi B, Borovitz Y, Tobar A, Yanay NB, Biton R, Angel-Korman A, Rappoport V, Leiba A, Bathish Y, Farber E, Kaidar-Ronat M, Schreiber L, Shashar M, Kazarski R, Chernin G, Itzkowitz E, Atrash J, Iaina NL, Efrati S, Nizri E, Lurie Y, Ben Itzhak O, Assady S, Kenig-Kozlovsky Y, Shavit L. Acute Kidney Injury and Hair-Straightening Products: A Case Series. Am J Kidney Dis 2023; 82:43-52.e1. [PMID: 36610611 DOI: 10.1053/j.ajkd.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/27/2022] [Indexed: 01/06/2023]
Abstract
RATIONALE & OBJECTIVE Keratin-based hair-straightening treatment is a popular hair-styling method. The majority of keratin-based hair-straightening products in Israel contain glycolic acid derivatives, which are considered safe when used topically. Systemic absorption of these products is possible, and anecdotal reports have described kidney toxicity associated with their use. We report a series of cases of severe acute kidney injury (AKI) following use of hair-straightening treatment in Israel during the past several years. STUDY DESIGN Case series. SETTING & PARTICIPANTS We retrospectively identified 26 patients from 14 medical centers in Israel who experienced severe AKI and reported prior treatment with hair-straightening products in 2019-2022. FINDINGS The 26 patients described had a median age of 28.5 (range, 14-58) years and experienced severe AKI following a hair-straightening procedure. The most common symptoms at presentation were nausea, vomiting, and abdominal pain. Scalp rash was noted in 10 (38%) patients. Two patients experienced a recurrent episode of AKI following a repeat hair-straightening treatment. Seven patients underwent kidney biopsies, which demonstrated intratubular calcium oxalate deposition in 6 and microcalcification in tubular cells in 1. In all biopsies, signs of acute tubular injury were present, and an interstitial infiltrate was noted in 4 cases. Three patients required temporary dialysis. LIMITATIONS Retrospective uncontrolled study, small number of kidney biopsies. CONCLUSIONS This series describes cases of AKI with prior exposure to hair-straightening treatments. Acute oxalate nephropathy was the dominant finding on kidney biopsies, which may be related to absorption of glycolic acid derivatives and their metabolism to oxalate. This case series suggests a potential underrecognized cause of AKI in the young healthy population. Further studies are needed to confirm this association and to assess the extent of this phenomenon as well as its pathogenesis.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem.
| | - Nabil Abu-Amer
- Institute of Nephrology and Hypertension, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Pazit Beckerman
- Institute of Nephrology and Hypertension, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Alexander Volkov
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Keren Cohen-Hagai
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Meidad Greenberg
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Sydney Ben-Chetrit
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba
| | - Kim Ben Tikva Kagan
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Shira Goldman
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Hadar Agmon Navarro
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Marwan Abu Sneineh
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Benaya Rozen-Zvi
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva
| | - Yael Borovitz
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Nephrology institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ana Tobar
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Pathology, Rabin Medical Center, Petah Tikva
| | | | - Ray Biton
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod
| | - Avital Angel-Korman
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod; Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | - Vladimir Rappoport
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | - Adi Leiba
- Nephrology and Hypertension Institute, Samson Assuta Ashdod University Hospital, Ashdod; Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba
| | | | - Evgeni Farber
- Nephrology Unit, Baruch Padeh Medical Center, Tiberias
| | - Maital Kaidar-Ronat
- Edith Wolfson Medical Center Ringgold Standard Institution, Edith Wolfson Medical Center, Holon
| | - Letizia Schreiber
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem; Department of Pathology, Edith Wolfson Medical Center, Holon
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya
| | | | - Gil Chernin
- Nephrology Institute, Kaplan Medical Center, Rehovot
| | - Eyal Itzkowitz
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
| | - Jawad Atrash
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
| | - Nomy Levin Iaina
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba; Department of Nephrology and Hypertension, Barzilai Medical Center, Ashkelon
| | - Shai Efrati
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology, Shamir (Assaf Harofeh) Medical Center, Zerifin
| | - Elad Nizri
- Department of Pathology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Department of Nephrology, Shamir (Assaf Harofeh) Medical Center, Zerifin
| | - Yael Lurie
- Clinical Pharmacology and Toxicology Section, Israel Poison Information Center, Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ofer Ben Itzhak
- Department of Pathology, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Suheir Assady
- Department of Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yael Kenig-Kozlovsky
- Clinical Pharmacology and Toxicology Section, Israel Poison Information Center, Nephrology and Hypertension, Rambam Medical Center; Department of Nephrology and Hypertension, Rambam Medical Center; B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem
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Shimizu MHM, Gois PHF, Volpini RA, Canale D, Luchi WM, Froeder L, Heilberg IP, Seguro AC. N-acetylcysteine protects against star fruit-induced acute kidney injury. Ren Fail 2016; 39:193-202. [PMID: 27845599 PMCID: PMC6014349 DOI: 10.1080/0886022x.2016.1256315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Star fruit (SF) is a popular fruit, commonly cultivated in many tropical countries, that contains large amount of oxalate. Acute oxalate nephropathy and direct renal tubular damage through release of free radicals are the main mechanisms involved in SF-induced acute kidney injury (AKI). The aim of this study was to evaluate the protective effect of N-acetylcysteine (NAC) on SF-induced nephrotoxicity due to its potent antioxidant effect. Materials and methods: Male Wistar rats received SF juice (4 mL/100 g body weight) by gavage after a 12 h fasting and water deprivation. Fasting and water deprivation continued for 6 h thereafter to warrant juice absorption. Thereafter, animals were allocated to three experimental groups: SF (n = 6): received tap water; SF + NAC (n = 6): received NAC (4.8 g/L) in drinking water for 48 h after gavage; and Sham (n = 6): no interventions. After 48 h, inulin clearance studies were performed to determine glomerular filtration rate. In a second series of experiment, rats were housed in metabolic cages for additional assessments. Results: SF rats showed markedly reduced inulin clearance associated with hyperoxaluria, renal tubular damage, increased oxidative stress and inflammation. NAC treatment ameliorated all these alterations. Under polarized light microscopy, SF rats exhibited intense calcium oxalate birefringence crystals deposition, dilation of renal tubules and tubular epithelial degeneration, which were attenuate by NAC therapy. Conclusions: Our data show that therapeutic NAC attenuates renal dysfunction in a model of acute oxalate nephropathy following SF ingestion by reducing oxidative stress, oxaluria, and inflammation. This might represent a novel indication of NAC for the treatment of SF-induced AKI.
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Affiliation(s)
| | | | - Rildo Aparecido Volpini
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Daniele Canale
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Weverton Machado Luchi
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Leila Froeder
- b Nephrology Division , Federal University of São Paulo , São Paulo , Brazil
| | | | - Antonio Carlos Seguro
- a Department of Nephrology, School of Medicine , University of São Paulo , São Paulo , Brazil
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