Article Text

  1. W. E. De Jesus-Monge1
  1. 1Clinical Research Program, Department of Medicine, University of Puerto Rico, San Juan, PR.


Introduction In 1997, 42% of Americans used alternative therapies, including herbal supplements, to treat illness. Caucasian ethnicity, female sex, age 35 to 49 years old, college education, and annual income greater than $50,000 are variables associated with the use of alternative therapies to treat disease. Patients look for additional therapies because of adverse events or lack of efficacy from conventional medicines. Advantages that herbal supplements provide are easy availability and a relatively low cost. The disadvantages of use of herbal supplements are that it is almost impossible to find data on their specifics, there is no certainty about quality and equivalency, and they do not have to be initially approved by the Food and Drug Administration. Both beneficial and adverse events on kidney function have been reported with the use of herbal supplements.

Objective To present a discussion on the beneficial and adverse events on kidney function associated with the use of herbal supplements.

Method An extensive and thorough review of the literature was performed using multiple medical literature databases.

Results Some of the commonly used herbs that have been associated with kidney protection are Astragalus (proteinuria reduction in chronic glomerulonephritis) and Ganoderma lucidum (combination with vasodilators causes suppression of proteinuria in nephrosis with focal segmental glomerulosclerosis). Some of the commonly used herbs that have been associated to kidney toxicity are wild mushrooms (tubular interstitial nephritis and fibrosis), cat's claw (acute renal failure), noni fruit (hyperkalemia), and St. John's wort (increased probability of transplant rejection).

Discussion Studies revealed that 60% of people using alternative therapies do not report the use to their health care providers. Multiple mechanisms have been proposed for the benefit and toxicity on kidney function from herbal supplements. An additional concern is the use of adulterated herbal products since many contain nephrotoxic heavy metals, pharmaceutical drugs, and pesticides. There are no data on potential dialysability of either active compounds or their potentially active or toxic metabolites.

Conclusions The quality and equivalency of herbal therapy are uncertain. Although potential renal toxicities may occur with herb ingestion, many herbal supplements have the potential to become valuable complementary therapy in the treatment of various renal disorders and in the protection against iatrogenic nephrotoxicity. Further high-quality research is needed to reach stronger conclusions on the benefits and toxicities on kidney function from herbal supplements.

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