We presented in detail a case of AIN that emerged in a patient who consumed Chenopodium album for one week. To the best of our knowledge, this report represents the first such case in the literature. There are many cases of kidney failure in the clinical setting with unexplained etiology. This case emphasizes the importance of careful use of medications, including herbal medicines and traditional treatments. It highlights the necessity for healthcare professionals to obtain a comprehensive history, including factors such as nutritional status, herbal product usage, medication history, and genetic background, to understand the patient’s condition better. Moreover, it underscores the need for further research on the side effects of herbal products.

Chenopodium album is known to be consumed in various regions of the world, believed to have protective effects against hepatotoxicity induced by carbon tetrachloride according to animal experiments [7,8,9]. However, there is insufficient research on its side effects, interactions with drugs, and the potential for contamination with heavy metals.

AIN is usually confirmed when histological findings such as interstitial inflammation, edema, and tubulitis accompany acute kidney injury (AKI). The etiology of AIN is diverse, with known causes including drugs, various infections, autoimmune or systemic diseases, and idiopathic conditions. Several studies have shown that drugs are the most common etiology of AIN. Furthermore, AIN reported after the intake of herbal medicines has been documented [10]. In our case, the presence of findings such as tubular atrophy, interstitial fibrosis, and mononuclear inflammatory cell infiltration with dense eosinophils in the interstitium led to the diagnosis of AIN (Fig. 3).

The pathogenesis of AIN typically involves allergic reactions triggered by exposure to a specific drug. T-cell-mediated hypersensitivity reactions and cytotoxic T-cell injuries play a role in the pathogenesis of AIN [11]. The exact disease mechanism leading to AIN caused by Chenopodium album is not clear based on the current data. Additionally, the kidneys are a sensitive organ to heavy metal poisoning, which can occur due to both acute and chronic exposure. Heavy metals taken into the body can lead to kidney lesions such as acute tubular necrosis, cortical necrosis, and interstitial nephritis. Exposure to heavy metals, both acutely and chronically, can cause tubulointerstitial injuries without any marked morphological changes, and these can manifest within days after exposure to the toxic substance. Heavy metal exposure constitutes a significant yet inadequately understood cause of kidney damage. The pathology findings, including crystals seen in the tubules, suggest this possibility. However, the absence of symptoms commonly observed in heavy metal poisoning cases, such as encephalopathy, seizures, mental status changes, papilledema, ataxia, and abdominal pain, makes this diagnosis challenging [12, 13].

The cornerstone of AIN treatment is discontinuation of the suspected nephrotoxic agent. There is a general consensus that when there is no evidence of improvement in kidney function after 5–7 days following the discontinuation of the suspected toxin, treatment, especially with steroids initiated promptly, may be beneficial. The rationale for this approach is that early corticosteroids may reduce the inflammatory infiltration of the renal interstitium and thereby prevent later fibrosis risk [11, 14]. In our case, a thorough evaluation of history, physical examination, laboratory, and pathological findings led to the initiation of steroid therapy, combined with hemodialysis due to electrolyte disturbances, acidosis, and uremic symptoms, resulting in a positive outcome.

In conclusion, we aimed to provide a multidisciplinary perspective on the diagnosis and management of AIN following the use of herbal products through this case. Physicians should inquire about the history of exogenous substance use and conduct a comprehensive assessment, keeping such situations in mind. Conscious use of herbal medicines and traditional treatments can help prevent serious complications like kidney damage.