Aristolochic Nephropathy Research Articles

Herbal nephropathy – a serious condition based on the innocence of nature


 Introduction and purpose: This study aimed to discuss herbal supplement usage in population and possible harmful effects with a strong emphasis on the kidneys health.
 Materials and methods: A literature search was conducted in the PubMed MEADLINE database of medical publications using the following keywords: herbal nephropathy, aristolochic nephropathy, herbal supplementation, Chinese traditional medicine
 Results: Despite the widespread use of herbs among the general public, awareness of possible side effects appears to be negligible. The herbal medicine market is often unregulated, moreover, there are problems with correct identification of the plant, variable cultivation, its processing and the lack of accurate information about its biological activity. Possible side effects include frequent contamination of preparations with heavy metals, other substances such as hormones, aflatoxins or pesticides. In addition, herbs can directly affect the metabolism of drugs taken for specific medical indications. They are able to change the level of their absorption, metabolism in the liver and secretion. The kidneys are a special organ exposed to the harmful effects of herbs due to their high blood flow, resorption from the renal tubules and high metabolic activity. Among kidney damage, aristolochic nephropathy is the one worth mentioning, induced by the herb Aristolochia fangchi and causing a rapidly progressing kidney disease, largely ending up with the need for dialysis or kidney transplantation.
 Conclusion: The use of herbs as medical substances carries dangers. They should be prevented through proper education of the society, appropriate legal regulations and doctors' awareness of their occurrence.
 

Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? PRO.

Chronic interstitial nephritis in agricultural communities (CINAC), also named CKD of unknown origin (CKDu) or Mesoamerican nephropathy (MeN), is defined as a form of CKD affecting young men and—less often—women. Its etiology is unrelated to diabetes, GN, hypertension, or other known causes of CKD. Patients with CINAC live and work mainly in poor agricultural communities, often in hot tropical regions, and are exposed to potentially toxic agrochemicals through work by ingestion of contaminated food and water, and/or by inhalation (1,2). The epidemic dimension of CINAC was first observed in the 1990s in Sri Lanka and Central America and has since been found to be an important cause of CKD-related deaths in an increasing number of countries (3,4). Patients with CINAC have bilateral, small, irregularly contoured kidneys with mutual size discrepancy of <1.5 cm on ultrasound, as observed in advanced cases of analgesic nephropathy and aristolochic nephropathy (5,6). Almost all patients with CINAC exhibit a proximal tubular lesion: tubular cell atrophy, basement membrane thickening, deficient proximal tubular cell (PTC) regeneration, loss of function, distal tubular proliferation/hypertrophy, and variable extents of interstitial fibrosis and cellular infiltration. Overt glomerular injury is rare in the early stages, whereas secondary glomerulosclerosis develops in later CKD stages. By electron microscopy, PTCs demonstrate enlarged dysmorphic lysosomes (≥1.2 µ m) containing homogenous nonmembrane-bound, electron-dense, rounded/irregular “aggregates” dispersed throughout the light-to-medium, uniform, electron-dense lysosomal matrix (7) (Figure 1). These features are also observed in a number of toxin-induced nephropathies. Figure 1. Overview of the constellation of proximal tubular lesions observed in patients with chronic interstitial nephritis in agricultural communities/CKD of unknown origin. (A) Proximal tubular cells containing many enlarged argyrophilic granules, demonstrated to be lysosomes (arrowheads) (7) (Periodic acid–Schiff methenamine [PASM] staining). (B) Affected proximal tubule demonstrating enlarged lysosomes, flattened atrophic epithelial cells with …