Effects of Herbal Supplements on the Kidney

Wendell Combest; Marian Newton; Austin Combest; June Hannay Kosier

Disclosures

Urol Nurs. 2005;25(5):381-386. 

In This Article

Plants With Known Direct Renal Toxicity

The most dramatic and highest profile case of herbal nephrotoxicity occurred from 1990-1992 in over 100 people in Belgium who ingested a Chinese weight loss/slimming remedy containing aristolochic acid principally from the plant Aristolochia fangchi (Vanherweghem et al., 1993). Seventy of these patients required renal transplants or dialysis and 30 subsequently developed urothelial carcinoma. In 2000, the FDA identified two new cases of interstitial renal fibrosis from aristocholic-containing herbal products. The resulting nephropathy is referred to as "aristolochic acid nephropathy" or less accurately "Chinese herb nephropathy." Aristolochic acid is a nitrophenanthrene carboxylic acid which forms DNA adducts in renal as well as other tissues after metabolic activation (Volker, Stiborova, & Schmeister, 2002). The DNA adducts result in genotoxic mutations resulting in urothelial carcinoma as well as the characteristic renal interstitial fibrosis and extensive loss of cortical tubules. Aristolochic acid is found in several other plants particularly in the Asarum and Bragantia genera. Hundreds of additional cases have been reported in several European and Asian countries since these early reports in Belgium. The FDA has imposed strict guidelines to prevent any Chinese herbal products containing aristolochic acid from entering the U.S. market.

A similar type of nephropathy has been reported in the Balkans and has been termed "Balkan endemic nephropathy" (Tatu, Oren, Finkelman, & Feder, 1998). The causative agent in this type of nephropathy is plant products contaminated by the fungal mycotoxin ochratoxin A. It also forms mutagenic DNA adducts in renal tissue which likely underlies the observed pathology.

Many traditional medicines and foods especially in the tropical regions of Africa and Asia contain renal toxic plants. One such food/medicine is the djenkol bean, a pungent smelling edible fruit of the hardwood tree Pithecellobium labatum (Areekul, Kirdudom, & Chaovanapricha, 1976). A 70% ethanol extract of the djenkol bean containing the toxic compound djenkolic acid was fed to monkeys, rats, and mice. Histologic examination of their kidneys showed severe tubular necrosis with a lesser degree of glomerular cell necrosis. A traditional remedy in South Africa called "Impila" is made from the roots of the plant Callilepis laureola. It is used to treat a number of conditions and has marked hepatic and renal toxicity. The renal damage caused is characterized by acute proximal convoluted tubule and loop of Henle necrosis which can lead to kidney failure (Stewart, Steenkamp, van der Merwe, Zuckerman, & Crowther, 2002).

There have been reports of acute renal failure in individuals ingesting wild mushrooms containing the nephrotoxin orellanine (Mount, Harris, Sinclair, Finlay, & Becker, 2002). Renal biopsy showed marked tubular interstitial nephritis and fibrosis. There has been one case report of acute renal failure in a patient with systemic lupus erythematosus taking the popular Peruvian herb cat's claw (Uncaria tomentosa) (Hileps, Bellucci, & Mossey, 1997).

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