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Acute kidney injury associated with the use of traditional medicines

Nature Clinical Practice Nephrology volume 4, pages 664–671 (2008)Cite this article

Abstract

The use of traditional medicine is common worldwide, with rates of use of over 80% in some populations. Considering the large number of people using traditional remedies throughout the world, it does seem that most do so without major adverse effects. Nevertheless, many folk medicines can cause kidney injury. Drug-induced nephrotoxicity reportedly contributes to up to 26% of cases of hospital-acquired acute kidney injury (AKI) and 18% of cases of community-acquired AKI globally, and folk remedies account for up to 35% of cases of AKI in the developing world. The kidney is highly susceptible to toxic insults because its intrinsic functions expose it to exceptionally high concentrations of any particular toxic substance. Clinical syndromes of nephrotoxicity can be defined according to the predominant regions of the kidney affected by the toxin, and reversibility of the injury is likely related to the severity and nature of the injury and also to the duration of toxin exposure. In countries with well-developed health-care systems, a large proportion of patients with nephrotoxicity will recover at least some renal function with adequate supportive care and dialysis. Health-care practitioners in all countries should be aware of the high prevalence of the use of alternative therapies and should be proactive in obtaining this information from patients. In poorer countries, where large proportions of the population rely on traditional medicine, attempts should be made to integrate traditional healers into the health-care system.

Key Points

  • Use of traditional remedies is common worldwide, with rates of use exceeding 80% in some populations; case reports indicate that a variety of these remedies can cause acute kidney injury

  • The nephrotoxicity of traditional medicines is multifactorial and can be a result of direct toxicity of the compound per se, or can be due to contaminants, incorrect use of the remedy, inadvertent substitution of a different substance or concurrent illness

  • Particular clinical syndromes of nephrotoxicity depend on the predominant regions of the kidney affected by the toxin

  • A large proportion of patients with renal injury related to traditional remedies will recover some renal function with adequate supportive care and dialysis

  • Physicians should question patients routinely about use of alternative therapies

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Authors and Affiliations

  1. VA Luyckx is an Assistant Professor in the Division of Nephrology and Immunology at the University of Alberta, and S Naicker is Professor and Head of the Division of Nephrology at the University of the Witwatersrand, Edmonton, AB, Canada, Johannesburg, South Africa.,

    Valerie A Luyckx & Saraladevi Naicker

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  1. Valerie A Luyckx
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Correspondence to Saraladevi Naicker.

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Supplementary information

Supplementary Table 1

Traditional medicines and edible plants associated with acute kidney injury or acute transplant rejection. (DOC 151 kb)

Supplementary Table 2

Traditional medicines and edible plants associated with chronic renal disease (often presenting as de novo renal dysfunction). (DOC 43 kb)

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Luyckx, V., Naicker, S. Acute kidney injury associated with the use of traditional medicines. Nat Rev Nephrol 4, 664–671 (2008). https://doi.org/10.1038/ncpneph0970

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