Natural Medicines Causing Acute Kidney Injury

https://doi.org/10.1016/j.semnephrol.2008.04.010Get rights and content

Summary

The use of alternative remedies derived from plants and animals is increasing worldwide. Their source and composition varies depending on the prevalent local practices. They are not tested for efficacy and safety; their ingredients are unknown and the dosage and route of administration are not standardized. Potentially toxic chemicals are added to them to increase their potency and mistaken identity has led to the use of toxic plants instead of the originally intended herb. Kidneys play a vital role in the metabolism and excretion of these substances and acute kidney injury is a common and important manifestation of their toxicity. The most usual renal lesions include acute tubular necrosis, cortical necrosis, and interstitial nephritis. Patients often present late to hospitals with multi-organ involvement. The diagnosis may be missed if the history is not sought specifically. These factors culminate in high mortality rates. Study of this entity is difficult because of the remoteness of the areas, unfamiliarity with local cultures, and mystery and secrecy surrounding the natural medicines used. Physicians need to be aware of this condition to make a timely diagnosis and provide appropriate management. Public awareness and regulation of the use of these medicines are required to eradicate this entity from the community.

Section snippets

Herbal Medicine Toxicity

There are many reasons for the popularity of natural medicines. In the economically poor countries, a combination of ignorance, poverty, nonavailability of health facilities, high cost of modern medicines, and the widespread belief in indigenous systems forces the people to turn to local exorcists, faith healers, and witch doctors for their medical needs.10, 11, 12 Many cultures, especially those on the African continent, believe that a disease state reflects disharmony between the person and

AKI due to Herbal Medicines

AKI may be the sole manifestation or develop as part of a multisystem involvement that may include acid-base disturbances, liver failure, neurologic abnormalities, disseminated intravascular coagulation, or respiratory failure. The importance of toxic AKI caused by indigenous medications has been highlighted in reports emerging from sub-Saharan Africa and parts of Asia.5 According to some experts, poisoning with traditional medicines is one of the main causes of high mortality rates in many

Pathogenesis of Natural Medicine–Induced AKI

Kidneys are particularly vulnerable to toxic injury because of their high blood flow rate, large endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH.15 Renal tubules are involved in active transport and urinary concentration, and therefore the local concentration of these toxins is high, leading to direct injury to tubular cells. Other mechanisms include renal ischemia caused by volume loss or a hemodynamic

References (121)

  • Y.H. Yeh et al.

    Short-term toxicity of grass carp bile powder, 5alpha-cyprinol and 5alpha-cyprinol sulfate in rats

    Comp Biochem Physiol C Toxicol Pharmacol

    (2002)
  • P.A. De Smet

    Herbal remedies

    N Engl J Med

    (2002)
  • R.J. Huxtable

    The harmful potential of herbal and other plant products

    Drug Saf

    (1990)
  • international liaison brings global vision to OAM

    Compl Alt Med NIH

    (1996)
  • Herbal medicines: A worldwide review

  • Complementary medicine

  • D.M. Marcus et al.

    Botanical medicines—the need for new regulations

    N Engl J Med

    (2002)
  • S.E. Straus

    Herbal medicines—what's in the bottle?

    N Engl J Med

    (2002)
  • A.H. Maclennan et al.

    Prevalence and cost of alternative medicine in Australia

    Lancet

    (1996)
  • C.H. Gold

    Acute renal failure from herbal and patent remedies in blacks

    Clin Nephrol

    (1980)
  • P.H. Joubert

    Toxicology units in developing countries: different priorities?

    J Toxicol Clin Toxicol

    (1982)
  • P. Joubert et al.

    The role of prospective epidemiology in the establishment of a toxicology service for a developing community

    S Afr Med J

    (1982)
  • D. Larrey

    Hepatotoxicity of herbal remedies

    J Hepatol

    (1997)
  • K.S. Chugh et al.

    Acute renal failure in special settings: tropical countries

  • L.S. Otieno et al.

    Acute renal failure following the use of herbal remedies

    East Afr Med J

    (1991)
  • Y.K. Seedat

    Acute renal failure among blacks and Indians in South Africa

    S Afr Med J

    (1978)
  • M.N. Lowenthal et al.

    Acute renal failure in Zambian women using traditional herbal remedies

    J Trop Med Hyg

    (1974)
  • N. Buchanan et al.

    Poisonings associated with witchdoctor attendance

    S Afr Med J

    (1976)
  • T.A. Adelekun et al.

    The pattern of acute toxic nephropathy in Ife, Nigeria

    West Afr J Med

    (1999)
  • V.A. Luyckx et al.

    Acute renal failure associated with the use of traditional folk remedies in South Africa

    Ren Fail

    (2005)
  • E.L. Bamgboye et al.

    Acute renal failure at the Lagos University Teaching Hospital: a 10-year review

    Ren Fail

    (1993)
  • A.N. Clark et al.

    A case of Podophyllium poisoning with involvement of the nervous system

    Br Med J

    (1957)
  • A. Wade

    The extra pharmacopeia

  • J.P. Dunn et al.

    Colonic complications after toxic tribal enemas

    Br J Surg

    (1991)
  • I. Segal et al.

    Ritual-enema-induced colitis

    Dis Colon Rectum

    (1979)
  • C.G. Bremner

    Ano-rectal disease in the South African Bantu, 1Bowel habit and physiology

    S Afr J Surg

    (1964)
  • K. Saito et al.

    [Rhabdomyolysis due to Paraphenylenediamine (hair dye)—report of an autopsy case]

    Nippon Hoigaku Zasshi

    (1990)
  • D. Zaid

    Takaout induced acute renal failure

    Semin Uronephrol Pitie Salpetriere

    (2002)
  • R.J. Ko

    Adulterants in Asian patent medicines

    N Engl J Med

    (1998)
  • E. Ernst

    Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review

    J Intern Med

    (2002)
  • Am Au et al.

    Screening methods for drugs and heavy metals in Chinese patent medicines

    Bull Environ Contam Toxicol

    (2000)
  • Product review: Asian and American ginseng. Vol 2002. Consumerlab.Com, LLC, 2002. [cited 2007 October 28]. Available...
  • A.B. Abt et al.

    Chinese herbal medicine induced acute renal failure

    Arch Intern Med

    (1995)
  • S. Cheng

    Heavy metals in plants and phytoremedication

    Environ Sci Pollu Res

    (2003)
  • S.K. Dwivedi et al.

    Medicinal herbs: a potential source of toxic metal exposure for man and animals in India

    Arch Environ Health

    (2002)
  • S. Bauer et al.

    Alteration in cyclosporine A pharmacokinetics and metabolism during treatment with St John's wort in renal transplant patients

    Br J Clin Pharmacol

    (2003)
  • C.I. Bagnis et al.

    Herbs and the kidney

    Am J Kidney Dis

    (2004)
  • A. Hutchings et al.

    Observations on the use of some known and suspected toxic Liliiflorae in Zulu and Xhosa medicine

    S Afr Med J

    (1989)
  • Y.K. Seedat et al.

    Acute renal failure in blacks and Indians in South Africa—comparison after 10 years

    Nephron

    (1993)
  • J. Wainwright et al.

    Toxic hepatitis in black patients in Natal

    S Afr Med J

    (1977)
  • Cited by (69)

    • Current insights toward kidney injury: Decrypting the dual role and mechanism involved of herbal drugs in inducing kidney injury and its treatment

      2020, Current Research in Biotechnology
      Citation Excerpt :

      The demand for medicinal plants is high in developed and developing countries since they possess healing power, which is due to their complex chemical constituents. In Western pharmacopoeia, more than 50% of drugs are prepared from herbs, or the chemicals which are derived derived from natural sources (Jha and Rathi, 2008). The natural products contain many phytochemicals like alkaloids, flavonoids, terpenoids, lignans, etc.

    • Phytochemicals of herbs and spices: Health versus toxicological effects

      2018, Food and Chemical Toxicology
      Citation Excerpt :

      Kidneys play a key role in the digestion and excretion of these chemicals and acute kidney injury is a typical and imperative indication of their toxicity. Renal injuries include acute tubular necrosis, cortical necrosis, and interstitial nephritis (Jha and Rathi, 2008). According to WHO, the exposure level to different toxicants changes from low amounts to very high doses, might be chronic or restricted to a single occasion, and the damage may result from subjection to a single substance or various chemicals.

    • Imaging in Urology

      2018, Imaging in Urology
    View all citing articles on Scopus
    View full text