Luyckx Valerie A, Steenkamp Vanessa, Stewart Michael J
Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
Ren Fail. 2005;27(1):35-43.
The use of folk remedies is widespread throughout Africa. Acute renal failure (ARF) is one of the most severe, but under-recognized, complications of folk remedy use. This report aims to describe the clinical presentation, outcomes, and nature of renal injury in patients with folk-remedy-associated ARF. Clinical data were evaluated retrospectively in 78 patients with ARF associated with recent folk remedy use. ARF was defined as elevated serum urea and creatinine above the age-appropriate normal ranges, persistent oligoanuria, worsening renal function with time, or need for dialysis. Overall mortality in patients with ARF was 41%. Mortality was higher in adults (45.5%) than in infants (36.6%), in patients with both renal and liver dysfunction (62.5%) than in those with renal dysfunction alone (22.6%), and in HIV-positive (44.4%) versus HIV-negative (34.6%) patients. Vomiting (51.3%) and diarrhea (43.6%) were the most frequent presenting symptoms. Metabolic acidosis (80.8%) and volume depletion (62.8%) were the most frequent clinical findings. The definable causes of ARF were pre-renal (26.9%), acute tubular necrosis (ATN; 26.9%), hepatorenal syndrome (6.4%), urinary tract infection/sepsis (7.7%), and primary renal disorders (7.7%). Twenty-seven patients had concomitant medical conditions unlikely primarily related to folk remedy ingestion. In conclusion, ARF occurring after use of folk remedies in South Africa is associated with significant morbidity and mortality. The most common contributors to ARF in this setting are volume depletion and ATN. Significantly, although a proportion of patients have underlying systemic or renal conditions that may contribute to renal dysfunction, in the majority of patients, folk remedy use appears to be the most likely proximate cause. In view of the large numbers of Africans living abroad, more widespread awareness of this important clinical problem needs to be raised.
民间疗法在非洲广泛使用。急性肾衰竭（ARF）是使用民间疗法最严重但却未得到充分认识的并发症之一。本报告旨在描述与民间疗法相关的急性肾衰竭患者的临床表现、转归及肾损伤的性质。对78例近期使用民间疗法后发生急性肾衰竭的患者的临床资料进行了回顾性评估。急性肾衰竭定义为血清尿素和肌酐高于相应年龄的正常范围、持续性少尿、肾功能随时间恶化或需要透析。急性肾衰竭患者的总体死亡率为41%。成人死亡率（45.5%）高于婴儿（36.6%），合并肾和肝功能不全患者的死亡率（62.5%）高于单纯肾功能不全患者（22.6%），HIV阳性患者（44.4%）高于HIV阴性患者（34.6%）。呕吐（51.3%）和腹泻（43.6%）是最常见的首发症状。代谢性酸中毒（80.8%）和容量耗竭（62.8%）是最常见的临床发现。急性肾衰竭可明确的病因包括肾前性（26.9%）、急性肾小管坏死（ATN；26.9%）、肝肾综合征（6.4%）、尿路感染/脓毒症（7.7%）和原发性肾脏疾病（7.7%）。27例患者伴有不太可能主要与服用民间疗法相关的内科疾病。总之，在南非使用民间疗法后发生的急性肾衰竭与显著的发病率和死亡率相关。在这种情况下，急性肾衰竭最常见的原因是容量耗竭和急性肾小管坏死。值得注意的是，虽然一部分患者有潜在的全身性或肾脏疾病可能导致肾功能不全，但在大多数患者中，使用民间疗法似乎是最可能的直接原因。鉴于大量非洲人生活在国外，需要提高对这一重要临床问题的更广泛认识。
