Jering (pithecellobium jeringa) is a local fruit, which is associated with acute renal failure when consumed in large amount. Jering contains 1-2% djengkolic acid, an amino acid that precipitate in acidic condition, leading to viscous urine formation causing microcrystalline hydronephrosis and obstructive nephropathy, glomerular injury and acute tubular necrosis.
Patient present within 48 hours of ingestion with typical symptoms :
- Hematuria
- Abdominal colic
- Oliguria
- Asymptomatic microscopic hematuria
- Mild abdominal colic
- Frank hematuria
- Severe loin pain
- Supra-pubic pain
- Dysuria
- Nausea
- Diarrhea
- Constipation
- Urine and breath had a pungent odour resembling ‘jering’ smell
Investigation shows
- Raise urea and creatinine.
- Normal potassium, without acidosis on ABG
- Normal ultrasound of kidney
- Minimal or absent of hydronephrosis
Management
- Conservative therapy ; aggressive hydration with normal saline and maintaining a good urine output with diuretics. Alkalinization of urine using sodium bicarbonate.
- Surgical intervention ; patient with prolonged anuria may not respond to conservative treatment. Urgent bilateral ureteric flushing should be considered. Jelly-like material is usually found. Post flushing, treat with aggressive hydration to maintain a good urine flow.
Source – Sarawak Handbook of Medical Emergencies 3rd edition
Mentaqarrub diri kepada Allah,profesional doktor dalam genggaman
1 comment:
I had seen a patient with jering nephropathy in Klinik Kesihatan Tampin NS. Although it is uncommon (or maybe common actually) but it is about the skill and knowledge of physician who clerking the case to know etiology of nephropahy. It never cross my mind until I seen the case for real with ultraasound KUB shows multiple cystic nephropahty.
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