Turmeric-Associated Oxalate Nephropathy

Introduction: Turmeric contains Curcumin which has anti-inflammatory properties that may be beneficial in patients with osteoarthritis, hyperlipidemia, pruritus, and Rheumatoid Arthritis. Thus it's a popular herbal supplement. Here we present a rare case of severe acute kidney injury (AKI) due to calcium oxalate nephropathy in a patient with heavy turmeric consumption. Case Description: An asymptomatic 69 year male with no significant past medical/ surgical history was evaluated for a spike in Creatinine from 1.2 to 3.1mg/dl over a few months. There was no history of drug/NSAID use, contrast exposure, or other nephrotoxins. He did mention taking Turmeric 2g daily for the past 2 years. There was no personal or family history of nephrolithiasis. Urine sediment was bland. Serum C3, C4, ANA, ANCA, anti-GBM, anti-dsDNA, hepatitis BCserum oxalate was also high at 14micromol/L. Genetic testing(AGXT mutation) for primary hyperoxaluria(PH) is pending, but lack of recurrent nephrolithiasis or nephrocalcinosis or systemic oxalate deposition and only marginally high S.oxalate make PH less likely. Discussion: Although many herbal remedies have shown promising results, these supplements often evade the rigorous standards that conventional therapies are subject to. Turmeric has long been used for anti-inflammatory & analgesic benefits and recently was publicized as an immunity booster and studied for prophylactic and therapeutic use in COVID. Compelling evidence for its efficacy comes from osteoarthritis trials, but recommendations for safe daily allowances aren't elucidated. Contrarily, turmeric has demonstrated increased urine oxalate excretion, a known cause of oxalate stones and, presumably, oxalate deposition in tubules. Hyperoxaluria mainly occurs secondarily in malabsorption syndromes. Loss of oxalate-degrading gut flora from antibiotics contributes and PH, a disorder of oxalate overproduction, is a rare cause. Several factors can interplay, but the contribution of oxalate-rich food like spinach, starfruit, and in this case, turmeric is indisputable. We recommend a high suspicion index and a thorough medication review in patients with severe AKI.