Nephrotoxins Hiding in Plain Sight

This academic presentation, part of an internal medicine meeting, focuses on nephrotoxins that are often overlooked in clinical practice. The speaker, Dr. Boitumelo Mashigo, discusses two main categories: traditional remedies and gym supplements. For traditional remedies, she highlights that many patients, particularly in African communities, use herbal preparations that may be contaminated with heavy metals like lead, mercury, and chromium, leading to chronic kidney disease. She cites a study from Pretoria showing high prevalence of traditional medicine use among patients with kidney failure. The second part addresses anabolic steroids and protein supplements. Anabolic steroids can cause focal segmental glomerulosclerosis (FSGS) and acute interstitial nephritis (AIN) through direct toxicity and hemodynamic effects. Protein supplements, while generally safe in healthy individuals, may increase GFR and potentially contribute to hyperfiltration injury in those with underlying risk factors. The presentation emphasizes the importance of asking patients about traditional remedy use and supplement intake, and suggests screening for hypertension and renal function in high-risk groups.