Hair staritining procedure in teenagers - not as straight forward as we thought.

The rising use of hair straitening in younger ages has become a medical issue, since glycolic acid and formaldehyde may be present, even in "formaldehyde free" labeled products. Formaldehyde – a colorless material, evaporates during the hair straitening procedure, inhaled and absorbed into the blood stream causing oxidative stress and cytotoxic damage to the proximal tubule cells leading to acute renal failure. Glycolic acid, is processed to Glyoxalate and eventually to Oxalate. Oxalate depositions may also cause acute kidney injury (AKI). Here we present three cases of female teenagers with AKI, shortly after a hair straitening procedures. All patients had acute renal failure with features of tubular damage and kidney biopsies of the first 2 cases showed acute tubular necrosis, one with oxalate deposition and the other with unidentified depositions. Two cases required acute dialysis, and shortly after commencing it, kidney function improved out of proportion to dialysis extent. We believe that in the presented cases, the prompt dialysis cleared a nephrotoxic ingredient, allowing improvement of renal function therefore preventing long standing and maybe even permanent damage. The aim of this case presentation is to highlight the danger of hair straitening products in pediatric population as well as to increase the index of suspicion among adult and pediatric nephrologists.