Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nephrology (Carlton). 2010 Jun;15 Suppl 2:10-7. doi: 10.1111/j.1440-1797.2010.01305.x.
Alternative and indigenous systems of medicine are popular amongst the poorer sections of society in the developing world. Their use in the developed world has also increased in recent times. The source and composition of these medicines vary in different parts of the world, but herbs and other botanicals are central to these systems. Largely outside the ambit of regulatory control, herbal remedies are prepared by quasi-trained herbalists and not tested for safety. Toxicity can occur when a herb with unknown toxicity is consumed, incorrect identification leads to substitution of an innocuous herb with a toxic one, preparations are contaminated with toxic non-herbal compounds or when a herb potentiates the nephrotoxic effect of a conventional therapy. Renal injury has been reported in association with several herbs. The best-known herb-induced chronic kidney disease (CKD) is aristolochic acid nephropathy. The condition is characterized by progressive interstitial nephritis, with a proportion of patients developing urothelial malignancies. The toxic compound is aristolochic acid (AA); AA-DNA adducts have been identified in the renal and urothelial tissues. Recent evidence suggests that AA also contributes to the development of Balkan endemic nephropathy. The role of herbs has been postulated in the development of CKD in other parts of the developing world, especially amongst the rural population. Public awareness and regulation of use of herbal medicines are required to eradicate this entity from the community.
在发展中国家，较贫困社会阶层中较流行替代和传统医学。最近，在发达国家，这些医学的应用也有所增加。这些药物的来源和组成在世界不同地区有所不同，但草药和其他植物药是这些系统的核心。这些草药补救措施在很大程度上不受监管控制，由准培训草药医生制备，且未经安全性测试。当食用毒性不明的草药时会发生毒性，不正确的鉴定会导致用无毒草药代替有毒草药，制剂会被有毒的非草药化合物污染，或者草药会增强常规疗法的肾毒性。已有报道与几种草药有关的肾损伤。最著名的草药引起的慢性肾脏病（CKD）是马兜铃酸肾病。该病症的特征是进行性间质性肾炎，一部分患者会发展为尿路上皮恶性肿瘤。有毒化合物是马兜铃酸（AA）；在肾和尿路上皮组织中已鉴定出 AA-DNA 加合物。最近的证据表明，AA 也促成了巴尔干地方性肾病的发展。在发展中国家的其他地区，尤其是农村地区，人们已经推测草药在 CKD 的发展中起作用。需要提高公众意识并规范草药的使用，以从社区中消除这种药物。
