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Djenkolism: case report and literature review

Authors Bunawan NC, Rastegar A, White K, Wang N

Received 27 November 2013

Accepted for publication 24 January 2014

Published 16 April 2014 Volume 2014:7 Pages 79—84


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Video abstract presented by Nur C Bunawan.

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Nur C Bunawan,1 Asghar Rastegar,2 Kathleen P White,3 Nancy E Wang4

1Alam Sehat Lestari Clinic, West Kalimantan, Borneo, Indonesia; 2Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; 3General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 4Department of Surgery and Pediatric Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA

Abstract: Djenkolism is an uncommon but important cause of acute kidney injury. It sporadically occurs after an ingestion of the djenkol bean (Archidendron pauciflorum), which is native to Southeast Asia. The clinical features defining djenkolism include: spasmodic suprapubic and/or flank pain; urinary obstruction; and acute kidney injury. The precise pathogenesis of acute kidney injury following djenkol ingestion remains unknown. However, it is proposed that an interaction between the characteristics of the ingested beans and the host factors causes hypersaturation of djenkolic acid crystals within the urinary system, resulting in subsequent obstructive nephropathy with sludge, stones, or possible spasms. We report a case of djenkolism from our rural clinic in Borneo, Indonesia. Our systematic literature review identified 96 reported cases of djenkolism. The majority of patients recovered with hydration, bicarbonate therapy, and pain medication. Three patients required surgical intervention; one patient required ureteral stenting for the obstructing djenkolic acid stones. Four of the 96 reported patients died from acute kidney failure. We stress the importance of awareness of djenkolism to guide medical practitioners in the treatment of this rare disease in resource-poor areas in Southeast Asia.

Keywords: djenkolism, acute renal failure, acute kidney injury, tropical medicine

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