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논문분류	춘계학술대회 초록집
제목	Irreversible End-Stage Kidney Disease After Short-Term Exposure to Tung Shueh Pill: A Second Reported Case of Herbal-Associated Nephropathy Complicated by -Restricted Multiple Myeloma
저자	Maria Felisa Eva Martin
출판정보	2026; 2026(1):
키워드	Herbal-associated nephrotoxicity, Acute kidney injury, End-stage kidney disease, Multiple myeloma, Tung Shueh pills
초록	Case Study: Chinese herbal medicines are widely used and commonly perceived as safe traditional therapies; however, increasing evidence has shown that some preparations may cause clinically significant nephrotoxicity. Tung Shueh pills, a proprietary Chinese herbal preparation frequently used for musculoskeletal pain, have been associated with kidney injury in only one previously reported case, which described biopsy-proven acute interstitial nephritis with subsequent renal recovery after discontinuation of the herbal preparation. We report a 75-year-old woman with no prior history of kidney disease who developed rapidly progressive kidney failure following ingestion of high-dose Tung Shueh pills for chronic back pain. One month after starting the medication, she presented with oliguria and severe azotemia requiring intermittent hemodialysis and subsequently progressed to irreversible end-stage kidney disease. Laboratory evaluation revealed persistent elevation of serum creatinine, markedly reduced estimated glomerular filtration rate, elevated cystatin C, and nephrotic-range proteinuria, while serum calcium remained normal at 8.46 mg/dL. Kidney biopsy was offered to investigate the abrupt onset of oliguria but was declined by the patient. Despite initiation of dialysis, her back pain worsened, prompting further evaluation. Magnetic resonance imaging of the spine demonstrated multiple lytic lesions suspicious for plasma cell dyscrasia, and bone marrow aspiration confirmed κ-restricted multiple myeloma. The patient was subsequently started on combination therapy with daratumumab, bortezomib, thalidomide, and dexamethasone (Dara-VTD). After three treatment cycles, a marked hematologic response was observed, with reduction of the serum free light chain κ/λ ratio from 352.8 to 3.4. Despite this favorable hematologic response, renal recovery did not occur and the patient remained dialysis dependent. To our knowledge, this represents the second reported case of kidney injury associated with Tung Shueh pill ingestion and the first documenting progression to irreversible end-stage kidney disease. The lack of renal recovery despite effective myeloma therapy suggests irreversible renal injury likely precipitated by herbal-associated nephrotoxicity.
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