Ginseng-Induced Diuretic Resistance

To the Editor. —Germanium, an ingredient in many ginseng preparations and over-the-counter nutritional supplements, has been associated with chronic renal failure. 1-3 To date, germanium-related acute adverse renal effects have not been reported. We describe a patient who became refractory to diuretics while ingesting germanium-containing ginseng. The patient's diuretic responsiveness improved after discontinuing these compounds. Report of a Case. —A 63-year-old man with membranous glomerulonephritis treated with furosemide and cyclosporine 4 was hospitalized because of edema and hypertension. He had started taking daily nutritional supplements, including 10 to 12 tablets of a germanium-containing ginseng preparation (Uncle Hsu's Korean ginseng), about 10 days earlier. At admission, he weighed 87.3 kg (194 lb), far more than his usual weight of 74.5 kg (164 lb). His blood pressure was 186/100 mm Hg, and serum creatinine was 115 μmol/L (1.3 mg/dL). We administered 240 mg of furosemide intraveneously (IV) every 8 hours, and ultrasound