Java Barb Fish Gallbladder–Induced Acute Kidney Injury and Ischemic Acute Hepatic Failure

Abstract

Introduction: Fish gallbladder is usually consumed in Asian countries as a traditional medicine. It improves fatigueness, arthritis, and erectile dysfunction. In Tasikmalaya, West Java, Indonesia, people believe if they consume fresh fish gallbladder of Java Barb (Barbonymus gonionotus) or so called “Tawes” will improves their healthy. In some reports, eating java barb can causes systemic toxicities such as acute kidney injury and acute hepatic failure. Acute kidney injury following consumption of java barb gall bladder has been reported in several Asian countries but it has never been reported before in Indonesia. Recently it has also been reported in the United States. Case: We reported one case of a hypertensive male 44 years old male after consumption of 5 pieces of java barb gallbladders. He got profuse vomiting, decreased urine output and developed edemas at both limbs and the scrotum within 3 days. He was diagnosed as prerenal acute kidney injury. Both his serum creatinine and serum ureum raised to 17,7 mg/dL to 193 mg/dL respectively. Meanwhile, he also developed ischemic acute hepatitis failure, with a ALT: 56 U/L, and AST: 536 U/L. He remained hypertensive (170/80 mmHg). Renal ultrasound detected no evidence of abnormalities. During admission, patient has been treated conservatively with restricted fluid management, bicarbonate tablet three times a day, amlodipine 10 mg a day, pantoprazole injection 40 mg a day. The urine output is more than 2000 mL/24 hours, no diuretics has been used. The patient did not require dialysis. After 10 days he was discharged from the hospital with a serum creatinine concentration 4,46 mg/dL, ureum 90 mg/dL ALT 17 U/L and AST 42 U/L. After a week discharged his serum creatinine concentration reached 1,83 mg/dL and his ureum 38 mg/dL. Conclusion: It seems acute kidney injury and acute ischemic hepatic failure after fish gallbladder consumption has an excellent prognosis. We suggested that this is an transient AKI induced by prerenal causes and toxicity of the gall bladder. A renogram and kidney biopsy should be perform and also a toxicological study of the gallbladder should be done.