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Nephrotoxicity of herbal products

par Baudoux, Thomas ;Nortier, Joëlle
Référence Toxicology of Herbal Products, Springer International Publishing, page (307-344)
Publication Publié, 2017-01

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Résumé :

The kidney is one of the major routes of excretion of drugs and metabolites, and given its high blood flow and metabolic activity, it is highly susceptible to injury by toxic drugs and herbs. In addition, high concentrations of toxic metabolites are in close contact with tubular cells due to urine concentration, especially during a state of fluid deprivation. The incidence of nephrotoxicity related to alternative medicines is not known. However, regarding the large number of individuals consuming herbs as alternative remedies and regarding the lack of control of over-the- counter products, clinicians should consider alternative medicine consumption in the differential diagnosis of unexplained kidney injury. This chapter will describe the major forms of renal involvement associated with the use of traditional medicinal products, including acute kidney injury, tubular function defects, electrolyte disturbances, systemic hypertension, chronic kidney disease, renal papillary necrosis, lithiasis, and urothelial cancer. The most famous example of kidney injury caused by herbal products is aristolochic acid nephropathy, which was first reported in 1993; it eventually involved hundreds of cases of chronic kidney disease and urothelial cancer in Europe and Asia, and raised global public health concerns. In addition, the so-called “Balkan endemic nephropathy” is obviously due to wheat contamination with the seeds of Aristolochia clematitis naturally growing in the fields, leading to chronic kidney failure and urothelial cancers. In addition to aristolochic acids included in Aristolochia species, several nephrotoxic herbs have also been written up in case reports and article reviews and are described in terms of their specific nephrotoxic pathways. Finally, besides these mechanistic aspects, we will review and compare various methods proposed to assess the renal toxicity of herbs and natural products, i.e., in silico, in vitro, and in vivo approaches. Further developments in “omics” investigation would be helpful for screening potential subjects at risk of developing kidney injuries.