Case of Purslane induced oxalate nephropathy: A report

Nephrotoxicity is characterized as rapid deterioration in the kidney function due to toxic effect of medications and chemicals. Toxic nephropathy is an important cause of renal injury, such as herbal nephropathy, and the mechanisms underlying renal poisoning include direct damage to tubular cells, renal ischemia, crystalluria, and allergic reactions.

Primary hyperoxaluria is an autosomal recessive disease that usually develops in childhood, whereas secondary hyperoxaluria is observed following excessive oxalate intake or reduced excretion, with no difference in age of onset. Oxalate nephropathy may be overlooked, and the diagnosis is often delayed or missed owning to the physician’s inadequate awareness of its etiology and pathogenesis.

A recent case study in BMC Nephrology discusses two cases of acute kidney injury (AKI) associated with the excessive consumption of purslane, one of which was confirmed as oxalate nephropathy by renal pathology and recovered rapidly after renal replacement therapy. The pathogenesis of hyperoxaluria with two case reports, and this report throws light to make appropriate treatment plans in clinical settings in the future.

Researchers report two cases of acute kidney injury, A 58-year-old woman with diabetes mellitus (DM) presented with elevated creatinine level and a 60-year-old woman was referred to the nephrology department owing to abdominal distension, vomiting, and chest tightness. The researchers considered it to be due to oxalate nephropathy in the setting of purslane (portulaca oleracea) ingestion. The two patients were elderly and presented with oliguria, nausea, vomiting, and clinical manifestations of acute kidney injury requiring renal replacement therapy. One patient underwent an ultrasound-guided renal biopsy, which showed acute tubulointerstitial injury and partial tubular oxalate deposition. Both patients underwent hemodialysis and were discharged following improvement in creatinine levels.

The researchers concluded that “Our report illustrates two cases of acute oxalate nephropathy in the setting of high dietary consumption of purslane. If a renal biopsy shows calcium oxalate crystals and acute tubular injury, oxalate nephropathy should be considered and the secondary causes of hyperoxaluria should be eliminated.”

Reference: Wang, X., Zhang, X., Wang, L. et al. Purslane-induced oxalate nephropathy: case report and literature review. BMC Nephrol 24, 207 (2023). https://doi.org/10.1186/s12882-023-03236-9.