Gabardi Steven, Munz Kristin, Ulbricht Catherine
Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA 02115-6110, USA.
Clin J Am Soc Nephrol. 2007 Jul;2(4):757-65. doi: 10.2215/CJN.00500107. Epub 2007 May 30.
Complementary and alternative medicine (CAM) is a multibillion-dollar industry. Almost half of the American population uses some form of CAM, with many using them in addition to prescription medications. Most patients fail to inform their health care providers of their CAM use, and physicians rarely inquire. Annually, thousands of dietary supplement-induced adverse events are reported to Poison Control Centers nationwide. CAM manufacturers are not responsible for proving safety and efficacy, because the Food and Drug Administration does not regulate them. However, concern exists surrounding the safety of CAM. A literature search using MEDLINE and EMBASE was undertaken to explore the impact of CAM on renal function. English-language studies and case reports were selected for inclusion but were limited to those that consisted of human subjects, both adult and pediatric. This review provides details on dietary supplements that have been associated with renal dysfunction and focuses on 17 dietary supplements that have been associated with direct renal injury, CAM-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with acute renal injury, and hepatorenal syndrome. It is concluded that it is imperative that use of dietary supplements be monitored closely in all patients. Health care practitioners must take an active role in identifying patients who are using CAM and provide appropriate patient education.
补充和替代医学（CAM）是一个价值数十亿美元的产业。近一半的美国人口使用某种形式的补充和替代医学，许多人在使用处方药的同时还使用这些方法。大多数患者没有告知他们的医疗服务提供者自己使用补充和替代医学的情况，而医生也很少询问。每年，全国中毒控制中心都会收到数千起因膳食补充剂导致的不良事件报告。补充和替代医学制造商无需证明产品的安全性和有效性，因为食品药品监督管理局对其没有监管。然而，补充和替代医学的安全性令人担忧。我们利用医学文献数据库（MEDLINE）和荷兰医学文摘数据库（EMBASE）进行文献检索，以探讨补充和替代医学对肾功能的影响。入选的英文研究和病例报告仅限于涉及成人和儿童人类受试者的研究。本综述详细介绍了与肾功能障碍相关的膳食补充剂，并重点关注了17种与直接肾损伤、补充和替代医学引起的免疫介导性肾毒性、肾结石、横纹肌溶解伴急性肾损伤以及肝肾综合征相关的膳食补充剂。得出的结论是，必须密切监测所有患者使用膳食补充剂的情况。医疗从业者必须积极识别使用补充和替代医学的患者，并提供适当的患者教育。
