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Review
. 2018 Oct 8;13(10):1605-1611.
doi: 10.2215/CJN.11571017. Epub 2018 Apr 3.

Nephrotoxicity and Chinese Herbal Medicine

Bo Yang  1   2 , Yun Xie  2   3 , Maojuan Guo  4 , Mitchell H Rosner  5 , Hongtao Yang  1 , Claudio Ronco  2   6
Affiliations
Review

Nephrotoxicity and Chinese Herbal Medicine

Bo Yang et al. Clin J Am Soc Nephrol. .

Abstract

Chinese herbal medicine has been practiced for the prevention, treatment, and cure of diseases for thousands of years. Herbal medicine involves the use of natural compounds, which have relatively complex active ingredients with varying degrees of side effects. Some of these herbal medicines are known to cause nephrotoxicity, which can be overlooked by physicians and patients due to the belief that herbal medications are innocuous. Some of the nephrotoxic components from herbs are aristolochic acids and other plant alkaloids. In addition, anthraquinones, flavonoids, and glycosides from herbs also are known to cause kidney toxicity. The kidney manifestations of nephrotoxicity associated with herbal medicine include acute kidney injury, CKD, nephrolithiasis, rhabdomyolysis, Fanconi syndrome, and urothelial carcinoma. Several factors contribute to the nephrotoxicity of herbal medicines, including the intrinsic toxicity of herbs, incorrect processing or storage, adulteration, contamination by heavy metals, incorrect dosing, and interactions between herbal medicines and medications. The exact incidence of kidney injury due to nephrotoxic herbal medicine is not known. However, clinicians should consider herbal medicine use in patients with unexplained AKI or progressive CKD. In addition, exposure to herbal medicine containing aristolochic acid may increase risk for future uroepithelial cancers, and patients require appropriate postexposure screening.

Keywords: Acute Kidney Injury; Alkaloids; Anthraquinones; Aristolochic Acids; Chinese Herbal; Chronic; Drugs; Fanconi Syndrome; Flavonoids; Glycosides; Heavy; Herbal Medicine; Humans; Incidence; Medicinal; Metals; Neoplasms; Nephrolithiasis; Plants; Renal Insufficiency; Traditional Chinese Medicine; chronic kidney disease; kidney; nephrotoxicity; rhabdomyolysis.

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Figures

Figure 1.
Figure 1.
Structure of aristolochic acid, one of the main components of nephrotoxicity of Chinese herbs.
Figure 2.
Figure 2.
Histologic picture of a case of AKI after oral intake of a hot water extract of Cupressus funebris. The figure shows glomeruli are essentially normal. Kidney tubules show thickened tubular basement membrane, and many epithelial cells are missing, necrotic, or flattened. Hemoglobin casts, interstitial fibrosis, and cellular infiltrate also are identified (periodic acid–Schiff stain). Original magnification, ×200.
Figure 3.
Figure 3.
Factors influencing the development of kidney disease associated with herbal medicine. The figure shows herb-related, treatment, and patient factors which may contribute to nephrotoxicity of hebal medicine.
See this image and copyright information in PMC

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