Introduction:
Dehydrated and well-processed fish gallbladder is touted as a traditional remedy for a variety of diseases. It has been widely documented that fish gallbladder causes acute renal damage and ischemic hepatitis, both of which are completely reversible if caught early. We report here a series of two cases of anuric acute kidney injury and severe hepatitis caused by the consumption of fish gallbladder, both of which recovered fully after a few sessions of hemodialysis
Methods:
First case is of a 40-year-old mechanic with no known previous comorbidity. He had been complaining of lower back pain for a few days, and during a regular blood test, he was found to have elevated glucose, which were normal on a repeat blood test. For the above, he consumed cooked fish gall bladder twice a day for 3 days. After 4 days of consumption, he developed vomiting, pain in the abdomen and reduced urine output, where it was less than 100ml for the next 3 days, while on the day of presentation he was anuric. Routine investigations showed severe renal dysfunction (creatinine - 13 mg/dl), severe hyponatremia (117 mmol/l), hepatitis (SGOT - 900) and severe metabolic acidosis. Urine analysis revealed numerous WBCs and RBCs , and no eosinophils were detected.He was given slow low efficiency dialysis for 1.5hrs for 2 continuous days with serial monitoring of sodium. Further 1 session of hemodialysis was done for 4 hours and renal biopsy was done. He was pulsed with Methylprednisolone 500mg/day for 3 days and given oral prednisolone 0.5mg/kg for 2 weeks . Renal biopsy showed acute tubular necrosis and acute interstitial nephritis with no interstitial fibrosis and tubular atrophy.
Second case is of a 32-year-old fisherman, who had no previously known comorbidities, had raw fish gallbladder for general health benefit for 4 days. He developed severe vomiting and pain abdomen around 5 days later. He noted reduction in urine output since the last few days. Routine investigations showed severe renal dysfunction (creatinine - 7.8mg/dl) and severe anicteric hepatitis. Investigations for tropical infections were all negative and as urine output started reducing over the next few days with rising creatinine with a peak of 10.8, he underwent 3 days of hemodialysis, followed by renal biopsy. Renal biopsy showed severe acute tubular necrosis with interstitial nephritis with no interstitial fibrosis and tubular atrophy.
Results:
The first patient's urine output gradually started to improve after 7 days. Serial monitoring of hepatic enzymes and serum creatinine were done which showed gradual reduction and normalisation at the end of 3 weeks. He continued on regular followup, and at the end of the first month his serum creatinine was 1.22mg/dl and normal hepatic enzymes, while he continued to have adequate urine output.
The second patient required few sessions of hemodialysis in view of his persistence oliguria. His urine output started to improve few days after the last hemodialysis session. He was pulsed with Methylprednisolone 500mg/day for 3 days and given oral prednisolone 0.5mg/kg for 4 weeks and tapered over another 2 weeks . Serial measurement of hepatic enzymes and serum creatinine showed gradual improvement and normalisation by the end of month.
Both the patients had complete recovery of renal function and hepatic enzyme levels at the end of one month of the illness and continue to do well on follow-up visits
Conclusions:
Fish gall bladder associated Acute kidney injury is a relatively rare entity . The prognosis is favourable, with most documented cases achieving normal renal and hepatic function and no severe long-term consequences.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.