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      THE PURVIEW OF PHYTOTHERAPY IN THE MANAGEMENT OF KIDNEY DISORDERS: A SYSTEMATIC REVIEW ON NIGERIA AND SOUTH AFRICA

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          Abstract

          Background:

          The kidney is tasked with a number of metabolic functions in the body. In its role as a detoxifier and primary eliminator of xenobiotics, it becomes vulnerable to developing injuries. Currently, over 1 million people in the world are living on renal replacement therapies (RRTs). The case in sub-Sahara African countries like Nigeria and South Africa is not any better than the global trend.

          Materials and Methods:

          A systematic review of medicinal plants used in the treatment of kidney disorders was conducted. Information were gathered from published scientific journals, books, reports from national, regional and international institutions, conference proceedings and other high profile intellectual resources. MeSH words like ‘prevalence of kidney disorders in Africa’, ‘renal replacement therapy’, ‘nephrotoxins or nephrotoxicants’, ‘nephroprotective plants’, ‘nephroprotective plants in Nigeria or South Africa’ and ‘nephroprotective phytocompounds’ were used to retrieve information from online databases (Google, Pubmed, MEDLINE, Science Direct, Scopus and SID).

          Results:

          Interestingly, our findings revealed that phytotherapy has emerged and is being employed to protect renal functions and delay progression of renal pathological conditions into end episodes where the last resort is RRT. In fact, in recent times, Phytotherapists are not only interested in developing relatively safe, more affordable, easily accessible and potent nephroprotective formulations but also increasing awareness on the prevalence of the disease and educating the populace on the probable preventive measures. More importantly, efforts at scientifically elucidating the pharmacological efficacy of the identified nephroprotective plants yet to be validated must be intensified through informed expert opinions. Till date, there is paucity of information on the concept of nephroprotection in most developing countries where kidney disorder is a major threat. Although, the concept is just emerging in South Africa, evidences have given credence to its application in complementary and alternative system of medicine in Nigeria.

          Conclusion:

          This review, therefore, reawaken researchers’ consciousness in the continuous search for auspicious nephroprotective plants that could potentially be excellent candidates in developing new lead drugs to manage and treat renal disorders.

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          Most cited references111

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          Cordyceps – A traditional Chinese medicine and another fungal therapeutic biofactory?

          Graphical abstract (a) The Yin and Yang symbol: The philosophical basis of some of the assumed properties and research on Cordyceps (see text)? (b) Cordyceps spp. parasitizing a dead Campanotus insect and (c) cordyheptapeptide A, a natural product from the fungus.
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            Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs.

            People who take analgesic drugs frequently may be at increased risk of end-stage renal disease (ESRD), but the extent of this risk remains unclear. We studied 716 patients treated for ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, D.C. The study participants were interviewed by telephone about their past use of medications containing acetaminophen, aspirin, and other nonsteroidal antiinflammatory drugs (NSAIDs). For each analgesic drug, the average use (in pills per year) and the cumulative intake (in pills) were examined for any association with ESRD. Heavier acetaminophen use was associated with an increased risk of ESRD in a dose-dependent fashion. When persons who took an average of 0 to 104 pills per year were used for reference, the odds ratio of ESRD was 1.4 (95 percent confidence interval, 0.8 to 2.4) for those who took 105 to 365 pills per year and 2.1 (95 percent confidence interval, 1.1 to 3.7) for those who took 366 or more pills per year, after adjustment for race, sex, age, and intake of other analgesic drugs. When persons who had taken fewer than 1000 pills containing acetaminophen in their lifetime were used for reference, the odds ratio was 2.0 (95 percent confidence interval, 1.3 to 3.2) for those who had taken 1000 to 4999 pills and 2.4 (95 percent confidence interval, 1.2 to 4.8) for those who had taken 5000 or more pills. Approximately 8 to 10 percent of the overall incidence of ESRD was attributable to acetaminophen use. A cumulative dose of 5000 or more pills containing NSAIDs was also associated with an increased odds of ESRD (odds ratio, 8.8), but the use of aspirin was not. People who often take acetaminophen or NSAIDs have an increased risk of ESRD, but not those who often take aspirin.
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              Drug-induced acute kidney injury.

              The purpose of this review is to describe the most prevalent mechanisms of drug-induced acute kidney injury, to define the risk factors for nephrotoxicity, and to analyze the available evidence for preventive measures. Drug toxicity remains an important cause of acute kidney injury that, in many circumstances, can be prevented or at least minimized by vigilance and early intervention. Recent studies have resulted in increased insight into the subcellular mechanisms of drug nephrotoxicity. Further improvement is to be expected from the identification of early markers of nephrotoxicity and an increasing involvement of a clinical pharmacist. The main mechanisms of nephrotoxicity are vasoconstriction, altered intraglomerular hemodynamics, tubular cell toxicity, interstitial nephritis, crystal deposition, thrombotic microangiopathy, and osmotic nephrosis. Before prescribing a potentially nephrotoxic drug, the risk-to-benefit ratio and the availability of alternative drugs should be considered. Modifiable risk factors should be corrected. The correct drug dosage should be prescribed. Patients should be pre-hydrated and the glomerular filtration rate should be frequently monitored during the administration of a potentially nephrotoxic drug. Studies are needed to further elucidate the mechanisms of nephrotoxicity to design more-rational prevention and treatment strategies. Computer-based prescriber-order entry and an appropriately trained intensive care unit pharmacist are particularly helpful to minimize medication errors and adverse drug events.
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                Author and article information

                Journal
                Afr J Tradit Complement Altern Med
                Afr J Tradit Complement Altern Med
                AJTCAM
                African Journal of Traditional, Complementary, and Alternative Medicines
                African Traditional Herbal Medicine Supporters Initiative (ATHMSI) (Nigeria )
                0189-6016
                2505-0044
                2016
                12 August 2016
                : 13
                : 5
                : 38-47
                Affiliations
                [a ]Phytomedicine and Phytopharmacology Research Group, Department of Plant Sciences, University of the Free State, QwaQwa Campus, Phuthaditjhaba 9866, South Africa
                [b ]Department of Microbial, Biochemical, and Food Biotechnology, University of the Free State, Bloemfontein, South Africa
                Author notes
                Article
                AJTCAM-13-38
                10.21010/ajtcam.v13i5.6
                5416643
                28487892
                70cb64d8-f9e3-41c5-bbc4-78b75eaf9ac6
                Copyright: © 2016 Afr. J. Traditional Complementary and Alternative Medicines

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

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                bioactive principles,nephroprotective,nephrotoxic,renal replacement therapy,silent killer

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