Reversible acute renal failure in a middle aged woman secondary to intravascular hemolysis caused by favism

A ۵۸-year-old woman was referred with the complaints of nausea, vomiting and left flank pain since last night. She had a history of renal colic during previous years and in this presentation, she received medication for relieving the pain. She was discharged from the clinic with analgesic drugs and intravenous (IV) line therapy with normal saline. Urine analysis revealed, +۱ blood and ۴-۵ red blood cells (RBCs) in microscopic urine sediment. When she presented to us, she was anuric and had severe pain in the left flank. She had a history of favism after exposure to beans a few years ago. She had consumed some food containing beans ۲ days ago. On admission, she had severe left flank pain and anuria of ۱۲ hours duration. She had dyspnea and on physical examination had end-expiratory crackles in the base of both lungs. The relevant laboratory tests on the day of admission and several days thereafter are summarized in Table ۱. Her peripheral blood film showed polychromasia, anisocytosis, poikilocytosis and blister cells.