Tuesday, June 12, 2012
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 :
- Abdominal colic
- Asymptomatic microscopic hematuria
- Mild abdominal colic
- Frank hematuria
- Severe loin pain
- Supra-pubic pain
- Urine and breath had a pungent odour resembling ‘jering’ smell
- Raise urea and creatinine.
- Normal potassium, without acidosis on ABG
- Normal ultrasound of kidney
- Minimal or absent of hydronephrosis
- 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
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