Colson Conny R D, De Broe Marc E
Department of Nephrology, University of Antwerp, Antwerp, Belgium.
Adv Chronic Kidney Dis. 2005 Jul;12(3):261-75. doi: 10.1016/j.ackd.2005.03.006.
In the developing world, up to 80% of the population uses traditional medicine for primary health care. In industrialized countries, adaptations of traditional medicine, termed "complementary" or "alternative" medicine (CAM), are used by a growing number of patients for preventive or palliative care. However, alternative medicine (AM) may be an important risk for the development of acute and chronic kidney injury because of several factors: nonconventional preparations rarely meet the required essential standards of consistency in composition and biological activity; many of these products contain undisclosed over-the-counter or prescription drugs or can be adulterated with hormones and glandular extracts; herbal preparations can be contaminated by pesticides and heavy metals; and because of errors in plant identification and confusing terminology, opportunities for mistakes and deliberate substitution can occur. Furthermore, there is a lack of reports of adverse events and drug interactions because of a lack of professional surveillance, and specific data on systemic and kidney toxicity are not easily available. Kidney injury/kidney syndromes caused by AM consist of acute tubular necrosis/toxicity (eg, Fanconi's syndrome), acute interstitial nephritis, papillary necrosis, hypertension, kidney stones, urinary retention, chronic tubulointerstitial nephritis with fibrosis, urinary tract carcinoma, and acute rejection of the kidney transplant. To improve the care for patients using AM, extension of physicians' knowledge about its possible hazards and toxicity is essential. This review deals with acute and chronic kidney toxicity caused by animal-, plant-, and mineral-based, nonconventional medicine and kidney failure caused by drug interactions with AM.
在发展中国家，高达80%的人口使用传统医学进行初级卫生保健。在工业化国家，越来越多的患者使用经过改良的传统医学，即“补充”或“替代”医学（CAM）进行预防或姑息治疗。然而，由于多种因素，替代医学（AM）可能是急性和慢性肾损伤发生的一个重要风险因素：非常规制剂很少能达到成分和生物活性一致性所需的基本标准；这些产品中的许多含有未公开的非处方药或处方药，或可能被激素和腺体提取物掺假；草药制剂可能被农药和重金属污染；并且由于植物鉴定错误和术语混淆，可能会出现错误和故意替代的情况。此外，由于缺乏专业监测，不良事件和药物相互作用的报告较少，关于全身毒性和肾脏毒性的具体数据也不易获得。由替代医学引起的肾损伤/肾脏综合征包括急性肾小管坏死/毒性（如范科尼综合征）、急性间质性肾炎、乳头坏死、高血压、肾结石、尿潴留、伴有纤维化的慢性肾小管间质性肾炎、泌尿系统癌以及肾移植急性排斥反应。为改善对使用替代医学患者的护理，扩展医生对其潜在危害和毒性的认识至关重要。本综述探讨了由动物、植物和矿物类非常规药物引起的急性和慢性肾脏毒性，以及与替代医学药物相互作用导致的肾衰竭。
