As Doris listened to Dr. Spears illustrate the case, she carefully recalled her father’s activities and said, “Dr. Spears, I have never seen my father take any unknown drugs after his illness worsened nor did I see him take any traditional medicine, let alone Dutchman’s pipe.”

Then, she added, “Overall, he was in excellent health after his last kidney transplant with a relatively mild form of diabetes, so he had been taking metformin extended-release tablets, but that drug does not do harm to the kidneys and will not cause acute kidney failure.”

Dr. Spears nodded and said, “I understand. Dutchman’s pipe is just an example, but there are a lot of traditional medicinal ingredients out there that can trigger acute kidney failure, not just Dutchman’s pipe. There are many chemicals and organic compounds that have great nephrotoxicity.”

Doris asked, “Dr. Spears, is there any way to find out exactly what caused my father’s acute kidney failure?”

Dr. Spears said, “I’ve sent your father’s b