Introduction: Acute kidney injury (AKI) is defined as an increase in serum creatinine level with a possible decrease in urine output, according to the KDIGO system. The etiology is divided into three groups based on the anatomical location, which are prerenal, renal, and postrenal. In this report, we present a case about a girl who was referred to our ER due to a high BP with an abnormal renal profile result, and we diagnosed her with acute oxalate nephropathy-induced oliguric AKI after she used a herbal hair product with unknown composition. To our knowledge, oxalate nephropathy (ON) secondary to the hair straightening treatment is a common cause of AKI in the older population, not in pediatrics, as most papers were published related to adults. This paper will report the first case related to the pediatric age group in Saudi Arabia, and the aim is to raise awareness of the adverse effects associated with cosmetic products among the consumers and pediatricians.

Case Presentation: An 8-year-old girl was brought to our ER complaining of facial swelling and abdominal distention for 2 days after using an unknown herbal hair treatment. The associated symptoms were nausea, vomiting, loss of appetite, decreased urine output, and weight gain (3kg). She also had URTI 2 weeks ago. Her BP was high (136/85 mmHg), above the 95th percentile. The patient had erythema on the scalp and behind the ears and mild ascites in her abdomen. Several laboratory tests were taken, and the results showed a high level of creatinine- serum (574.85 umol/L) and BUN (30.6 mmol/L) with electrolyte disturbance. She was admitted to the PICU with the impression of severe oliguric AKI secondary to post-streptococcal glomerulonephritis, which might have been triggered by URTI or toxic nephropathy secondary to a hair product application. We managed her with fluids, diuretics, and anti-hypertensive medications. The imaging- guided percutaneous kidney biopsy was performed, and the final diagnosis was acute tubular necrosis caused by ON.

Conclusion: Hair products contain glycolic acid and formaldehyde substances, which have been associated with AKI. Education campaigns can play a crucial role in informing the pediatric population about the risks of using these products and encouraging safer alternatives.