Understanding Balance between Advertent Healing and Inadvertent Harm by Traditional Remedies: A Case Series of Naphthalene-Induced Acute Kidney Injury in Northwest India

Abstract

Aim: This study aims to highlight the risks associated with unsanctioned indigenous medical practices and advocate for increased awareness and medical oversight. Case presentation: We present four cases that presented to Nephrology department of SMS medical college & hospital, Jaipur, Rajasthan between January 2024 to July 2024 who developed anuria after ingesting a naphthalene ball mixed with a sweet as a home based remedy for treatment of haemorrhoids. They had pronounced renal dysfunction and evidence of hemolysis. All four cases were in age group ranging from 23 to 35 years, with three being males and one female. Comprehensive care was provided, encompassing supportive measures such as hemodialysis to address the renal impairment. Subsequent renal biopsy unveiled pigment cast nephropathy as the underlying etiology of AKI in all the patients. With continuous treatment and vigilant observation, urine output of all patients progressively recovered in 11 to 16 days, and all patients were discharged in a stable condition with declining trend of serum creatinine. All patients had normal renal function at 3 month follow up. Discussion: Naphthalene is an aromatic hydrocarbon with two condensed rings. It is used to manufacture moth balls, insecticides, dyes and toilet deodorant blocks. Naphthalene is known to have toxic effects, particularly on the hematological system which occurs through the generation of free oxygen radicals, causing headache, nausea, vomiting, diarrhoea, abdominal pain, fever and altered mental status. This case series serves as a poignant reminder of the imperative need for circumspection when utilizing indigenous remedies, highlighting the potential hazards of home based remedies. Furthermore, it underscores the significance of high index of suspicion, expeditious diagnosis, patient and doctor education, and the administration of appropriate therapeutics in instances of AKI linked to toxic exposures, thus ensuring favourable patient outcomes. Conclusion: We conclude that unsanctioned home based remedies should be used after thorough circumspection and, after consultation with a registered medical practitioner. The importance of regulatory oversight on traditional medicine usage should never be overlooked considering inadvertent harm such remedies can have on health if taken above a specified dose.