Japan has recently faced a public health crisis owing to "Beni Koji Choleste Help," a product marketed as a dietary supplement. It is made from red yeast rice and has cholesterol-lowering effects. Following the identification of the first case of acute kidney injury (AKI) caused by the product, 76 possibly related deaths and 492 hospitalizations have been reported in Japan. We herein demonstrate three cases of AKI with renal tubular acidosis and Fanconi syndrome following consumption of the product for 2 weeks to 7 months. Kidney biopsy revealed diffuse tubular injury, tubular cell flattening, loss of brush border, sparse debris, and cast formation containing periodic acid-Schiff- and silver stain-positive fluffy material in the tubular lumens with interstitial cell infiltration, together with mild fibrosis. Electron microscopy revealed fluffy materials in the tubular lumen surrounded by necrotic tubular cell debris and intracellular contents. Discontinuation of the supplement and the treatment with prednisolone improved kidney function and Fanconi syndrome. Longitudinal monitoring and surveys are required to detect and prevent the progression to chronic kidney disease in people who have consumed "Beni Koji Choleste Help."

中文翻译：

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3 例含红曲米补充剂诱导的急性肾损伤和 Fanconi 综合征。


由于“Beni Koji Choleste Help”，一种作为膳食补充剂销售的产品，日本最近面临公共卫生危机。它由红曲米制成，具有降低胆固醇的作用。在确定首例由该产品引起的急性肾损伤 （AKI） 病例后，日本已报告了 76 例可能相关的死亡和 492 例住院治疗。我们在此展示了三例服用该产品 2 周至 7 个月后出现肾小管性酸中毒和 Fanconi 综合征的 AKI 病例。肾活检显示弥漫性肾小管损伤、肾小管细胞扁平、刷状边界缺失、碎片稀疏，肾小管腔内形成含有高碘酸-希夫和银染色阳性蓬松物质的管型，伴有间质细胞浸润，伴有轻度纤维化。电子显微镜显示肾小管腔中有蓬松的材料，周围环绕着坏死的肾小管细胞碎片和细胞内内容物。停止补充剂和泼尼松龙治疗改善了肾功能和范可尼综合征。需要进行纵向监测和调查，以检测和预防食用“Beni Koji Choleste Help”的人发展为慢性肾病。