(Table 1). In the CKD group, mean serum creatinine was 2.4 mg/dl. 73% patients were in CKD stage 111. Conclusion: CKD was the most common renal syndrome observed in 44% patients. Mesangial proliferation followed by focal endocapillary proliferation were the predominant histological pattern observed in our study. SIVATHASAN SUDHAHARAN Department of Nephrology, Hospital Kuala Lumpur Djengkol bean (Pithecellobium jeringa) is frequently used in the Malay Archipelago as a staple in local cuisine and for its purported medicinal value (Figure). It contains djenkolic acid, a sulphur-containing
amino acid. Its precipitation in urine forms sludge, causing obstructive uropathy. Djenkolism has been reported almost exclusively involving the South East Asian population principally Malaysians and Indonesians. A healthy 44 year old Indonesian gentleman had consumed a kilogram of djengkol beans with RG7420 in vitro boiled rice (nasi ulam). He presented 48 hours later with colicky abdominal pain, inability to pass urine or have bowel openings. Examination revealed a distended abdomen with sluggish bowel sounds. There was no pedal edema. He had an initial urea of 14.8 mmol/L,
potassium 4.3 mmol/L and creatinine 443 μmol/L. It had deteriorated to a peak urea of 27.1 mmol/L and creatinine 1088 μmol/L. He had compensated metabolic acidosis, with a pH of 7.332, bicarbonate 12.1 mmol/L and BI 2536 clinical trial base excess −11.6. A urine examination revealed microscopic hematuria. An ultrasound on admission revealed good sized kidneys with mild right hydronephrosis but no calculi, confirmed by a CT urogram. He was anuric the first three days of admission despite aggressive hydration. Haemodialysis via a femoral catheter was performed twice. On day three of admission he developed frank haematuria and was put on bladder irrigation by the Urology team. He was initially planned for stent
insertion for obstructive uropathy; however the hematuria resolved and he was polyuric after bladder irrigation. As for the constipation, an abdominal Xray revealed prominent large bowel dilatation. He Megestrol Acetate was treated conservatively by the Surgical team. When he produced urine, he was also able to open his bowels. He was discharged well on day seven of admission with resolution of the acute kidney injury. Djenkolism occurs predominantly in males, with a seasonal increase between September and February in keeping with the rainy season and blossoming of the djengkol tree. The development of renal failure is not dependent on the method of preparation or amount consumed. The prognosis is good, with all case reports published reporting resolution of renal failure with conservative measures, one requiring bilateral stenting. This is believed to be the first report of djenkolism requiring acute dialysis, and one that caused acute intestinal obstruction.