<p class="first" id="d745198e203">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.
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