• Users Online: 547
  • Print this page
  • Email this page
REVIEW ARTICLE
Year : 2019  |  Volume : 5  |  Issue : 3  |  Page : 151-163

Taming the fire of nephrotoxic botanicals


1 Department of Renal Medicine, Centre for Integrative Chinese Medicine, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Western Education Centre; GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
2 Kidney Disease Section, NIDDK, National Institutes of Health, Bethesda, MD, USA
3 Department of Renal Medicine, Centre for Integrative Chinese Medicine, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Western Education Centre, London, United Kingdom

Correspondence Address:
Qi-He Xu
Department of Renal Medicine, Centre for Integrative Chinese Medicine, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Western Education Centre, Cutcombe Road, London SE5 9RJ
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wjtcm.wjtcm_2_19

Rights and Permissions

Criteria for diagnosing nephropathy and urothelial neoplasms induced by botanicals containing aristolochic acids (AAs) are well established. Highlights of recent research on AAs include mechanisms of AA intrarenal transport and metabolism and vigorous debate on whether AAs may also cause liver cancers. Many other botanicals may also cause renal injury, but a generalized framework for diagnosing botanical-induced kidney injury (BIKI) is lacking. Based on what we have learnt about the wide spectrum of phenotypes of BIKI attributed to AAs and a recently published standardized phenotypic framework of drug-induced kidney disease, we propose that BIKI may be categorized into six phenotypes (acute kidney injury, tubular dysfunction, glomerular disorders, nephrolithiasis, chronic kidney disease, and neoplasms) and four mechanistic types (A, predictable; B, idiosyncratic; C, chronic; and D, delayed). We call for international cooperation assembling a task force to develop, refine, and regularly appraise an online BIKI database, documenting botanical use, phenotypes, mechanisms, and levels of evidence. Once established, such a database may be linked with electronic patient records and pharmacovigilance channels to generate alerts, guide clinical decision-making, direct future research, and support evidence-based regulation of herbal medicines and education of healthcare professionals and the public. Finally, to prevent BIKI, we propose that a proactive approach integrating the triad of botanicals, users, and stakeholders will be needed.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed332    
    Printed32    
    Emailed0    
    PDF Downloaded36    
    Comments [Add]    

Recommend this journal