Table 2.
Individual patient characteristics
| Parameter | Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | Patient 7 | Patient 8 |
|---|---|---|---|---|---|---|---|---|
| Age | 65 | 35 | 52 | 58 | 35 | 32 | 38 | 30 |
| Sex | Male | Female | Female | Male | Female | Female | Female | Female |
| Indigenous druga | Siddha | Siddha | Siddha | Siddha | Siddha (Swasa Kalpa) | Siddha (Swasa Kalpa) | Ayurveda | Siddha (Rasaganthi mezhuhu) |
| Duration of indigenous medication intake, mo | 3 | 2 | 12 | 1 | 2 | 2 | 3 | 11 |
| Serum mercury, normal <10 μg/l | 16.4 | 21.5 | 71.2 | 32.1 | 18.3 | 22.4 | 38.6 | 73.4 |
| 24-h urinary mercury, normal <10 μg/d | 18.9 | 19.6 | 86.7 | 36.8 | 23.5 | 17.5 | 42.1 | 64.7 |
| Creatinine, mg/dl | 0.91 | 0.78 | 1.80 | 0.86 | 0.53 | 0.63 | 0.75 | 1.14 |
| eGFR, ml/1.73 m2 | 89.3 | 98.5 | 39.6 | 98.5 | 115.6 | 118.7 | 122.8 | 50.3 |
| Urine protein, g/d | 14.3 | 5.3 | 16.2 | 13.3 | 3.3 | 4.7 | 2.2 | 12.5 |
| Albumin, g/dl | 2.3 | 2.8 | 1.8 | 1.8 | 2 | 2.2 | 2.7 | 2 |
| Hemoglobin, g/dl | 13.3 | 11 | 11 | 12.4 | 14.3 | 11.1 | 11.8 | 13.5 |
| Light microscopy | MN,5% tubular atrophy, mild interstitial inflammation | MN, mild ATN, interstitial inflammation in 10% (foamy histiocyte) | MN,20% glomerulosclerosis, 10% ATN,10% IFTA, interstitial inflammation in 20% | MN, ATN, 15% interstitial inflammation in 10% |
MN | MN, mesangial proliferation in 20% | MN, focal interstitial infiltrates (lymphocytes and foamy macrophages) | Normal basement thickness by LMb, 10% ATN |
| IF microscopy | IgG 4+ C3 1+ C1q1+ |
No tissue C4d+ on IHC |
IgG 3+, IgM 1+, C3 1+ |
IgG 2+, C3 1+ |
IgG3+, IgA 2+, C3 1+ |
IgG 3+, C3 1+ |
IgG 4+, C3 trace C1q+ |
IgG 1+, C3 2+ |
| Treatment | Conservative | Conservative | Steroids ×2 wk | Conservative | Conservative | Conservative | Conservative | Steroids ×6 wk |
| Outcome | CR | CR | CR | CR | Not in remission | PR | CR | CR |
| Time to reach CR, mo | 15 | 17 | 01 | 18 | Lost to follow-up at 6 mo | 6 | 6 | 1 |
| Follow-up duration after attaining remission, mo | 48 | 18 | 20 | 3 | — | 11 | 9 | 24 |
| eGFR on last follow-up, ml/1.73 m2 | 74.8 | 103.5 | 41.1 | 95.6 | 123 | 121 | 121 | 82.4 |
ATN, acute tubular necrosis; CR, complete remission; eGFR, estimated glomerular filtration rate; IF, immunofluorescence; IFTA, interstitial fibrosis/tubular atrophy; IHC, immunohistochemistry, LM, light microscopy; MN, membranous nephropathy; PR, partial remission.
a
The system of medicine, as stated by the patients. Positive identification of the drug was not possible in patients 1 through 4 and 7 as the drugs had no labels or a prescription was not available.
b
Electron microscopy showed membrane thickening and subepithelial deposits.