Child Kidney Dis.  2019 Apr;23(1):48-52. 10.3339/jkspn.2019.23.1.48.

Acute Tubular Necrosis associated with the Ketogenic Diet in a Child with Intractable Epilepsy

• Yoo KH
• Yim HE

• KMID: 2448162
• DOI: http://doi.org/10.3339/jkspn.2019.23.1.48

Abstract

The ketogenic diet (KD) has been used as an effective antiepileptic therapy for intractable childhood epilepsy. However, various adverse effects have been reported with use of the KD. We report a case of a child who developed acute tubular necrosis subsequent to therapy with KD. A 5-year-old girl had myoclonic epilepsy with developmental delay. She was under the treatment with antiepileptic drugs since the age of 3 months and on the KD during the past 18 months. Proteinuria persisted intermittently with the initiation of the KD and subsequently increased in the past 2 months. She was admitted with intermittent mild fever, vomiting, and lethargy for the past 3-4 weeks. At the time of admission, she presented with hypertriglyceridemia, heavy proteinuria, renal Fanconi syndrome, and acute kidney injury. Renal sonography showed a marked increase in the size and parenchymal echogenicity of both kidneys. A renal biopsy revealed acute tubular necrosis accompanied by early interstitial fibrosis. After the withdrawal of the KD and supportive therapy, without changing other anticonvulsants and their dosages, improvement of renal function was observed. Proteinuria had disappeared after 1 month and kidney size returned to normal after 8 months. It is hypothesized that the KD can induce and/or aggravate the renal tubulointerstitial injury in some patients who are under the treatment with anticonvulsants.

Keyword

Acute kidney injury; Epilepsy; Ketogenic diet; Proteinuria

MeSH Terms

Acute Kidney Injury
Anticonvulsants
Biopsy
Child*
Child, Preschool
Drug Resistant Epilepsy*
Epilepsies, Myoclonic
Epilepsy
Fanconi Syndrome
Female
Fever
Fibrosis
Humans
Hypertriglyceridemia
Ketogenic Diet*
Kidney
Lethargy
Necrosis*
Proteinuria
Vomiting
Anticonvulsants