Herbal remedies for kidney health -
Renal dysfunction may also be induced by hepatorenal syndrome through supplementation of herbal substances that can cause hepatotoxicity; common ones include echinacea, yellow oleander, valerian, kava and pennyroyal.
A review on nephrotoxicity and Chinese herbal medicine by Yang and colleagues examined reported cases of renal dysfunction caused by traditional herbal medicines. The evidence reviewed came from case reports in which a kidney biopsy confirmed diagnoses or clinical observation substantiated mechanism of injury.
However, in many patients the exact pathology of AKI was unknown. The most common causes of AKI were acute tubular necrosis and acute interstitial nephritis. A number of herbal substances were shown to cause AKI see Table 2. In kidney disease, vitamin and mineral imbalances commonly occur.
Supplements can be hidden sources of both potassium and phosphorus, and due to limited regulation on supplement content, the consumer may not know how much the product contains.
The National Kidney Foundation provides a list of herbal supplements with potassium and phosphorus, such as stinging nettle leaf , turmeric rhizome , bitter melon, evening primrose, coriander leaf , American ginseng, flaxseed seed and water lotus among others.
Additionally, some herbal supplements may interfere with medication metabolism such as St. Johns Wort, echinacea, ginseng and ginkgo. Dietary supplements are rarely taken in pure form and instead are in mixtures of a variety of compounds, which could have interactions and make it difficult to isolate the offending nephrotoxin.
Unless a company voluntarily undergoes third-party testing for purity it can be difficult to know with certainty what is in supplement products. NSAIDs have been found in CAM products intended to provide an anti-inflammatory or analgesic benefit. Patients with CKD should avoid NSAIDs, and it is concerning that patients may unknowingly be exposed through concomitant medication or impurities in adulterated supplements, such as glucosamine, advertising pain relief, according to Gabardi and colleagues.
Heavy metal contamination is also a common concern. Common heavy metals that can cause renal dysfunction include arsenic, lead and mercury. Inappropriate processing techniques can also result in toxicity due to industrial dyes.
Yang and colleagues reported Carthamus tinctorius safflower , used for various medical conditions as an anti-inflammatory and analgesic, was found to be contaminated with Auramine O, a known carcinogenic industrial dye that can cause kidney and liver toxicity.
Errors in the manufacturing of herbal remedies can increase exposure to high-risk toxic herbal compounds. An example of this is the plant Asarum, which is commonly used as an herbal analgesic to treat headaches, toothaches and other inflammatory conditions.
The root of Asarum has a low concentration of aristolochic acid. However, if the whole plant is used in the manufacturing process, then it yields an herbal product with high risk of nephrotoxicity. There are examples of manufacturing errors and mistakenly using incorrect plants in the development of remedies.
Yang and colleagues found more than women in Belgium and France who reported extensive renal interstitial fibrosis from to after ingesting a weight loss compound that contained Aristolochia fanchi, which contains high levels of aristolochic acid, instead of the intended herb Stephania tetrandra.
Herbal medicine is growing in popularity. The immediate risk with supplements is little oversight and regulation. Taking supplements will always be a risk to the consumer because the FDA does not regulate dose, ingredients or purity.
Few studies show the real benefits of herbal supplements to consumers, and there are even fewer studies for the CKD population.
Due to the potential harm, it is important to increase awareness among health care professionals about the indications and potential consequences so patients with CKD and consumers can be appropriately educated.
Healio News Nephrology Nutrition. Issue: July By Amanda C. Wetherington, RD, LD. Fact checked by Gina Brockenbrough, MA. Read more. July 17, Add topic to email alerts.
Lastly, Li et al. have demonstrated the effect of Zhen Wu Tang, a classic herbal decoction from ancient China, in ameliorating kidney injury in rats having immunoglobulin A nephropathy.
Again, the adjustment of intestinal flora and the restoration of metabolism homeostasis are proposed to be the outcome of Zhen Wu Tang treatment. Moreover, three articles have focused on other aspects of therapeutic benefits in treating CKD.
First, exosomal miRNA profiling has been revealed in CKD rats. Liu et al. have found that 4 exosomal miRNAs were markedly disturbed, and which could be modulated by Jian-Pi-Yi-Shen formula, a Chinese herbal decoction, in adenine-induced CKD rats.
The article by Zhou et al. has shown that Jian-Pi-Yi-Shen herbal formula could restore renal oxidative injury by activating nuclear factor erythroid-derived 2 -like 2 signaling in CKD rats. Diabetic kidney disease is one of the leading causes of end-stage renal disease, and it is therefore of great importance to delay the progression of diabetic kidney disease.
Three articles are presented in this topic assessing renal protective effects of herbal medicine in diabetic animal models. Another study by Li et al. have revealed that Tang Shen herbal formula could attenuate diabetic kidney injury and reduce pyroptosis of tubular epithelia via TXNIP-NLRP3-GSDMD axis in diabetic rats.
The third article by Xuan et al. is revealing the effect of Yiqi Jiedu Huayu herbal decoction in diabetic nephropathy. Apart from herbal decoction, Yang et al. have reported the effect of Huidouba, a Tibetan medicine derived from the nest of Atypus karschi , in diabetic nephropathy.
Having an intake of Huidouba could down regulate the expression of Nox4 and relieve the oxidative injury in podocytes and proteinuria of diabetic nephropathy rats. Taken together, the aforementioned articles provide possible therapeutic strategies for treatment of diabetic kidney disease.
In addition, the therapeutic functions of herbal medicine on other kidney diseases have included here. Chao et al. have employed untargeted lipidomics to reveal action mechanism of Orthosiphon stamineus extract in treating nephrolithiasis. They found that the anti-stone effect of O.
stamineus extract was closely related to glycerolphospholipid-mediated oxidative stress and inflammatory response. In parallel, Xiong et al. have investigated the effect of I-BET, a small-molecule inhibitor targeting the bromodomain and extra-terminal BET protein, on the development of hyperuricemic nephropathy, which supports the notion that BET inhibition may have therapeutic potential in prevention and treatment of the problem.
Ten articles are focused on identifying active ingredients within herbal medicine to treat CKD. Fucoidan, a natural compound of Laminaria japonica , was reported to ameliorate renal injury-related calcium-phosphorous metabolic disorder and bone abnormality in CKD mineral and bone disorder rats by targeting FGFKlotho signaling axis Liu et al.
These data provide pharmacological evidence of fucoidan in the treatment of this disease. Ning et al. have shown that genistein could restore renal fibrosis by increasing alkylation repair homolog 5 to regulate epithelial-to-mesenchymal transition in unilateral ureteral occlusion-induced animal model.
The result provides new insight into the function of m6A modification in CKD progression. Emodin, the most important component of Rheum palmatum , was being prepared in nanoparticles to form an emodin-nanoparticle system.
This combination possessed higher stability and better colon adhesion in therapeutic effect on CKD Lu et al. He et al. have revealed that rhein and curcumin had a synergistic effect in ameliorating CKD, which provides an important explanation on the synergy of rhein and curcumin from a pharmacokinetic viewpoint.
have demonstrated that total flavones, containing rutin, hyperoside, isoquercitrin, and quercetin extracted from A. manihot , could regulate the amounts of gut microbiota and its metabolites, and which inhibit microinflammation by targeting autophagy-mediated macrophage polarization in CKD rats.
Astragaloside II protected podocyte injury and mitochondrial dysfunction in diabetic rats, possibly via a co-modulation of nuclear factor erythroid-derived 2 -like 2 and PTEN-induced putative kinase signaling Su et al. Li et al. have shown that scutellarin, a biologically active flavonoid derived from Erigeron breviscapus , restored renal injury via increasing cellular communication network factor 1 expression and suppressing nucleotide-binding oligomerization domain-like receptor protein 3 inflammasome in hyperuricemic nephropathy mice.
Cui et al. have investigated the effect of oleuropein, an active ingredient of Ilex pubescens , on acute kidney injury model. Their findings showed that oleuropein attenuated lipopolysaccharide-induced acute kidney injury both in vitro and in vivo by suppressing dimerization of toll-like receptor.
Zhou et al. have reported that glycyrrhetinic acid, a bioactive component of Glycyrrhiza uralensis , protected renal tubular cells against oxidative insult. The regulation of JNK-connexin thioredoxin signaling is proposed to play a crucial role in this action. Taken together, these findings can offer promising candidates for new drugs against CKD.
Two clinical studies here in this issue have highlighted application of herbal medicine on kidney disease. The first study by Mao et al. was a multicenter, double-blind, double-dummy, randomized controlled trial aiming to assess efficacy and safety of Bupi Yishen Chinese herbal formula in patients with non-diabetic CKD at stage 4.
The results indicated that the herbal formula possessed protective effects on non-diabetic patients with CKD in first 12 weeks and over 48 weeks. Another study by Guo et al. have analyzed a retrospective population-based cohort to evaluate the long-term effect of using Chinese herbal medicine among incident pre-dialysis patients with diabetic kidney disease.
The findings suggest that using Chinese medicine among pre-dialysis diabetic nephropathy patients is seemed to be feasible. Based on these two studies, a well-designed clinical study is still needed to evaluate the beneficial effect of herbal medicine in clinics.
Three articles in this topic explored the nephrotoxicity of herbal medicine and its prevention. First, Xu et al.
have summarized the mechanism underlying nephrotoxicity of compounds from herbal medicine, which may help in discovering the biomarkers of renal injury and developing preventive strategies. Aristolactam I, an active component from herbs, is considered to be the most important constituent causing aritolochic acid nephropathy Bastek et al.
Deng et al. have shown that mitochondrial iron overload-mediated antioxidant system could inhibit the aristolactam-induced ferroptosis in HK-2 cells. Besides, Gao et al. have shown the protective effects of astragaloside IV, a major saponin from Astragalus root, on chronic nephrotoxicity.
The results showed that astragaloside IV alleviated tacrolimun-induced chronic nephrotoxicity by enhancing p62 phosphorylation, thereby facilitating Nrf2 nuclear translation, and then decreasing ROS accumulation and renal fibrosis.
Overall, these studies provide possible strategies to reduce renal toxicity and to ensure the safety of clinical medication; however, which has to be confirmed by further research.
This research topic collects 37 articles including a wide range of studies in the field of herbal medicine to control CKD. These studies improve our understanding on the mechanisms of herbal medicine in treating CKD and its related diseases.
Potential therapeutic targets are also proposed for the prevention and treatment of CKD. Moreover, several active ingredients in herbal medicine are identified, which provides potential candidates for future drug development. The nephrotoxicity of herbal medicine and its prevention are also highlighted here.
Besides, clinical studies support beneficial role of herbal medicine in improving CKD. Thus, this topic can provide effective evidence to promote the development of herbal medicine as therapeutic use to treat CKD, and such that which may help to prolong the survival of patients and reduce the burden of CKD.
JC, KT, and Y-YZ: Concept, design, literature search and manuscript review. JC: acquisition of data, drafting the manuscript. All authors have read and approved the manuscript.
This work is supported by Natural Science Foundation of China , Natural Science Foundation of Guangdong Province A , Shenzhen Science and Technology Plan Project JSGG and ZDSYS , Traditional Chinese Medicine Bureau of Guangdong Province The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Bastek, H. Comparison of Aristolochic Acid I Derived DNA Adduct Levels in Human Renal Toxicity Models. Toxicology , 29— PubMed Abstract CrossRef Full Text Google Scholar. Chen, T. Chronic Kidney Disease Diagnosis and Management: A Review.
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