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RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 28
Research & Reviews: A Journal of Toxicology
ISSN: 2231-3834(Online), ISSN: 2349-1264(Print)
Volume 9, Issue 2
www.stmjournals.com
Nephrotoxic Effect of Herbal Medicine and
Supplements: A Review
Neelesh Kumar Maurya*
Department of Food and Nutrition, Institute of Home Science, Bundelkhand University,
Jhansi, Uttar Pradesh, India
Abstract
Nowadays, alternative medicines have become a multibillion-dollar industry and continue
growing. Herbal medicine is one of the primeval forms of medicine which is prepared
exclusively from herbal plants. The Ayurvedic medicinal cure method is also been used as a
prescription for chronic diseases such as cancer, asthma, diabetes, and end-stage renal
diseases and increasing interest in European countries respectively. According to the report
of world health organization (WHO), 4 billion people (80% of the world's population) use
herbal medicines for some perspective of primary healthcare; approximately 25% of modern
drugs used in the United States have been procured from plants. It is estimated that 11% of
the total 252 medicinal drugs found in crucial medicine list of WHO are particularly of plant
origin. The purpose of this study is to find out the toxic and beneficial effects of medicinal
herbs on renal health by which evidence for benefit or toxicity has been found. The review
aims to provide knowledge and guide to encourage future toxicity studies on the kidney by
medicinal herbs.
Keywords: Nephrotoxic herb, renal, medicinal plant, Ayurvedic medicine
*Author for Correspondence E-mail: neeleshkumar.maurya@gmail.com
INTRODUCTION
Not all of the plants are reported to be useful
are harmless. These contemplations underlie
the investigation of ethnomedicinal plants [1,
2]. As of late, an expanding number of
individuals have been utilizing integral and
elective prescriptions. In the United States, the
Dietary Supplement and Health Education Act
(DSHEA) of 1994 was set up to control
characteristic products [3,4]. This
demonstration initiated that regular items are
not required to experience premarketing
security and viability testing. The practice of
Ayurveda medicine is ancient and
phytochemicals are still the strength of
character of our pharmacopoeia because more
than 50% of drugs used in the Western
pharmacopoeia are derivates from herbs
[5].One of the main reasons for having natural
products chemistry resides in the actual or
latent pharmacological activity to be found in
alkaloids, terpenoids, flavonoids, and
Coumadin's, lignans. It is a popular belief that
alternative remedies like Ayurveda medicines
are safer to consume than allopathic
medicines. Herbal drugs have been around for
long of years, but it is important to exercise
caution when herbal concoctions are
prescribed by medical practitioners or
advertised in the media as "safe" and "natural"
cures to mild illnesses. Herbal medicines are
more potent; they are assorted with
pharmacologically active phytochemicals [6,
7]. When clubbed together, herbal medicines
may adversely interact with standard drugs [8].
Pregnant women, children and people with
pre-existing health conditions are particularly
at risk of their side effects. Renal injury has
been reported in association with several herbs
and the best-known herb-induced chronic
kidney disease (CKD) is aristolochic acid
nephropathy [9]. Toxicity can occur when herb
with unknown potent photochemical is taken;
incorrect identification leads to the
replacement of a harmless herb with a toxic
one, arrangements are contaminated with toxic
or non-herbal compounds and when a herb
potentiates the nephrotoxic effect of
Nephrotoxic Effect of Herbal Medicine Maurya Neelesh Kumar
RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 29
conventional therapy. A negative outcome is
noticeable a prospective trend of adding drugs
or analogues to herbs to make them more
effective, especially for an enhanced sexual
organism and weight loss. While numerous
advantages can be inferred from the utilization
of herbs, potential negative results cannot be
disregarded. Sapper et al., who detailed that
20% of Ayurvedic medicines acquired by
means of the internet contained quantifiable
degrees of mercury, lead, and arsenic [10].
Numerous home-grown item defilements have
been distinguished fundamentally containing
medications like alprazolam (Xanax® or
others) indomethacin (Indocin®, and others),
sildenafil (Viagra®), lovastatin (Mevacor®),
estrogens, and warfarin (Coumadin®, and
others). Herbs that may modify draining are
likewise of significance particularly inpatient
populaces with coagulopathies, on ant platelet
or anticoagulant drugs, or in careful patients.
Revira et al. announced a case of a careful
patient with delayed unexplained seeping in
the wake of taking enormous amounts of
natural tea and contained Mexican arnica. At
present time, numerous medicines utilized
today may cause comparative antagonistic
occasions if not observed or utilized
accurately. Dietary supplements and herbs are
easily trading on the internet; the people are
using them with self-diagnosis and self-
medication, without knowing their
pharmacokinetic and pharmodymanic effects
[11]. Herbal toxicity can increase in any of the
following situations like, (i) Consumption of a
herb with unidentified toxicity; (ii) Imprecise
identification foremost to the substitution of an
innocuous herb with a toxic one; (iii)
Accidental contamination with nephrotoxic
non-herbal drugs, pesticides or chemicals; (iv)
Potentiating of the toxic effect of a
conventional drug due to relations with a
compound present in the herb; and (v)
Consumption of meat from an animal that has
grazed on toxic plants[12].
Herb cannot be categorized as completely
harmful or beneficial categories. Indian
Ayurveda and Unani medicines use various
herbs by following different specials types of
procedures, and time is also another factor.
Some herbs prepared by very poisonous
substances; previous studies revealed that if
directly consumed then the outcomes are
potentially harmful.
HERBS WHICH ARE DIRECTLY
NEPHROTOXIC
Chinese Herb
Aristolochic corrosive (AA) is the most
copious one. The family Aristolochiaceae
incorporates the genera Aristolochia and
Asarum (wild ginger), this is generally utilized
in Chinese natural medication, and a few
clinical examinations discovered aristolochic
acid is associated or connected with the renal
issues, and hepatic and urothelial carcinoma.
Chinese medicines are utilized as diuretics and
analgesics. Specifically, containing
Aristolochia acids are regularly utilized for
reducing body weight. The FDA has issued
alerts with respect to the utilization of AA-
containing supplements. Various different
plants, especially from the Asarum and
Bragantia genera, contain aristolochic
corrosive. Patients present with renal
deficiency, a moderate rise in blood urea,
mellow proteinuria and extreme iron
deficiency. An extremely renowned endemic
nephropathy frequency was accounted for in
multi-decade it is likewise connected.
Aristolochic corrosive is also known as Balkan
endemic nephropathy; this condition has been
accounted for the Balkan states coming about
because of plant items defiled by the
contagious mycotoxins ochratoxin. What's
more, this additionally shapes mutagenic DNA
items in kidney tissues. Be that as it may, the
accurate aetiology of Balkan endemic
nephropathy is as yet a mystery [13, 14].
Djenkol Bean Poisoning (Djenkolism)
Djenkol bean is a reason for acute renal
failure. Djenkol bean effects after ingestion.
Manifestations have appeared such as, dysuria,
haematuria, leukocytosis, lower stomach and
reciprocal lumbar agony, oligo-anuria, the
entry of sandy particles in the pee and
hypertension, showing as an intense renal
disappointment. Djenkolic corrosive
influences serious cylindrical rot with a minor
degree of glomerular cell corruption in
creatures. Djenkolic corrosive structures are
needle-like gems, particularly in amassed
Research & Reviews: A Journal of Toxicology
Volume 9, Issue 2
ISSN: 2231-3834 (Online), ISSN: 2349-1264 (Print)
RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 30
acidic pee in distal tubules, prompting
deterrent and renal calculi formation [15, 16].
Impilea (Callilepis laureola)
Callilepis laureola is native tuber herb of sub-
Saharan Arica. Commonly known by Zulu
name “Impala”, meaning health to cure of a
number of complications, frequently specified
for the duration of pregnancy to make sure
easy childbirth, for sexually transmitted
diseases for fertility and blood purification.
Callilepis nlaureola affects renal if practising
regular furthermore long-term becomes the
cause of acute renal failure in the black
community of South African country.
Undesirable influence observed in 1 4 days in
more than 70 clinical symptoms becomes
unmistakable in 1 4 days in >70% of cases
showing as sickness and retching pursued by
hypoglycaemia principal to adjust sensorial
and convulsions [17]. The renal harm caused is
portrayed by intense proximal tangled tubule
and circle of Henle rot, which can prompt
kidney disappointment. The exact component
of renal damage is not clear, yet the dangerous
standard is thought to be the atractyloside, an
alkaloid that restrains the development of
Adenosine Diphosphate (ADP) over the
mitochondrial film, avoiding the combination
of Adenosine Triphosphate (ATP) and causing
renal cell deal [18].
Herbs which are Nephrotoxic (Long Term)
Feline's Paw (Uncaria tomentosa)
It is a powerful anti-inflammatory herb. Cat's
Claw is believed to fight the inflammation
associated with a number of gastrointestinal
problems. It is also used to treat a wide range
of other digestive disorders including IBS,
IBD, colitis, gastritis and peptic ulcers.
Feline's paw (Uncaria tomentosa), is a
Peruvian home-grown cure utilized for
gastritis, cirrhosis, gonorrhoea ailment, and
malignant growths of the female genital tract
and has been related with the improvement of
intense renal disappointment; and kidney
biopsy screening intense interstitial nephritis.
Home-grown medications can influence serum
potassium levels [19, 20].
Liquorice Root (Glycyrrhiza glabra)
Liquorice root is utilized as a herb; however
on the off chance that the long haul in
abnormal state influences aldosterone
hormone, bringing about sodium maintenance
and subsequent hypertension and
hypokalemia. Liquorice root contains
glycyrrhizic corrosive which undergoes
biochemical changes and hydrolysed to
glycyrrhetenic corrosive, which restrains renal
eleven type’s hydroxysteroid dehydrogenase
which is responsible for forestalling
inactivation of cortisol to cortisone. Collection
of cortisol in the kidney animates aldosterone
receptors in cells of cortical gathering conduit
bringing about sodium reabsorption. Laxative
herbs like Senna and rhubarb which are used
as laxatives [21].
Noni Juice
Noni juice is very popular and well-accepted
herbal product which has a significant variety
of phytochemicals that improve body immune
system, cure some diseases, and highly
rejuvenating properties. Due to the high
amount of potassium (56.3 meq/l) content, it
may cause hyperkalemia. It should be taken in
a prescribed proper quantity, recommended
concentration and balance amount intake in a
day [22, 23].
Dandelion, Horsetail, Stinging Nettle, and
Alfalfa
These are other popular rejuvenating herbs
which have a high content of potassium and
can also contribute to hyperkalemia. Herbal
medicines are having a high substance of
oxalic acid. Rhubarb is an across the board
home grown delicious yet has high oxalate
content and can advance the making of renal
calculi [24].
Star Fruit (Averrhoa carambola)
Star is an appetizing fruit. It is low in
carbohydrates yet filled with nutrient C, fibre
and cancer prevention agents. Carambola
organic products or star natural products have
incredible measures of calming properties and
cell reinforcements that may avert skin issue
like dermatitis. High concentration of oxalic
acid is present in the star fruit; it is not
recommended to be consumed in too much
amounts, especially if anyone has kidney
problems, otherwise they would suffer from
renal calculi [25].
Nephrotoxic Effect of Herbal Medicine Maurya Neelesh Kumar
RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 31
Cape aloes is an Aloe ferox Mill (A.
candelabrum A. Berger)
Typically perceived as the harsh aloe or Cape
aloe, it is a polymorphic species local to South
Africa. Cape aloes have been utilized since
antiquated occasions as a conventional chemo
preventive and hostile to tumour cure in
society prescription and it has a well-perceived
history of utilization as a diuretic.
Notwithstanding the plenty of customary
therapeutic uses, A. forex optional metabolite
mixes in aloe have been locked in to cause
parenchymatous nephritis and examination
studies have uncovered renal harm by causing
intense cylindrical corruption, recommending
that renal damage is expected to cause
dehydration [26].
Violet Tree, Wild Wisteria (Securidaca
longepedunculata)
It is a savannah bush, most of the time utilized
by conventional botanists. The home-grown
remedy of the violet tree is generally utilized
for the treatment of dysmenorrhoea, venereal
sicknesses just as an expectorant and
abortifacient. Violet tree root has natural
secondary metabolite methyl salicylate and
saponins which has observed potential
nephrotoxic in various scientific studies.
Kidney histology of treated rats showed
characteristics consistent with renal epithelial
injury from toxins [27].
African Mango (Irvingia gabonensis)
It is a neighbourhood leaf plant developed in
tropical woods in West Africa. It is widely
utilized in West African cooking and created
industrially. This plant remedy is very valuable
in weight decrease, skin illness, controlling
diabetes, hypolipidemic impact and so on. After
long haul expending this herb, the patient has
answered to grow quickly advancing
unfavourable effect on renal disappointment,
hepatic, heart after utilization of home-grown
arrangements from this plant [28].
Khat Leaf (Catha edulis)
Catha edulis Forsk is a little to medium
measured green tree refined by and large in
Eastern and Horn of Africa. Chewing Khat leaf
for its psychostimulatory and antidepressant-
like activity effect is a common habit of East
African people. Catha edulishas a side effect on
a number of gastrointestinal tract problems,
oesophagitis, and gastritis and delayed intestinal
absorption, as well as the development of oral
keratotic white lesions at the site of chewing.
Above herb has potential effect of diuretic and
its use needs cautions in a healthy individual
person as well as the renal compromised
patient. A portion of these herbs is used as
aggravations to the cylindrical cell while some
may modify serum electrolytes. Juniper berries
have terpene that is associated with one of the
risks of kidney disturbance and harm in excess
[29]. In Germany, parsley and goldenrod are
shown for the fundamental water system of the
urinary tract furthermore, for avoiding kidney
stones. The diuretic impact of parsley leaf and
root is because of its unstable oil (apiole and
myristicin) parts. Natural medicine items may
contain substantial metals. It is a broadly known
with certainty and that numerous home-grown
medicines, especially Ayurvedic home-grown
arrangements contain nephrotoxic
overwhelming metals viz. lead, mercury,
cadmium what's more, arsenic. Some heavy
metals are considered to have therapeutic
effects in the CAM specialities and the problem
lies in the fact that their concentration is not
standardised and there is unpredictability batch
to batch. The nearness of substantial metals and
their fixations are ordinarily not uncovered on
the marks of home-grown drugs. Natural
prescriptions are containing different
medications. It has been perceived that
numerous home-grown details contain non-
steroidal mitigating prescriptions which restrain
renal vasodilator prostaglandins and can prompt
renal disappointment. Natural medications are
having a high substance of oxalic acid [30].
Rhubarb, this is a common herbal preparation
but has high oxalate content and can promote
the formation of renal calculi. Star fruit
ingestion has been reported to produce acute
oxalate. Are some herbs nephroprotective also?
Silymarin derived from milk thistle (Silybum
marianum) seeds contains several potent
antioxidant flavonolignans [31].
Edible plants that have been associated with
chronic kidney injury are given in the Table 1.
Research & Reviews: A Journal of Toxicology
Volume 9, Issue 2
ISSN: 2231-3834 (Online), ISSN: 2349-1264 (Print)
RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 32
NEPHROPROTECTIVE HERBS
Silymarin has renal defensive impacts in
creatures because of its cancer prevention agent
impacts against harming free radicals and by
the righteousness of invigorating RNA and
protein blend which is very significant for renal
and hepatic fix instruments and furthermore
secures kidney cells in culture from medication
instigated nephrotoxicity, and secures against
trial cyclosporine nephrotoxicity[41]. Picroliv
(Picrorhiza kurrooa), is a mainstream
restorative Ayurvedic herb and it is removed
from the rhizomes and roots which secured the
kidney in a renal ischemia-reperfusion initiated
damage model in rats [42]. Astragalus, a
celebrated Chinese herb, is powerful by
tentatively prompted glomerulonephritis in
rodents, particularly in diminishing protein
urea. Cordyceps, a growth discovered
developing in caterpillar hatchlings of specific
moths, is esteemed as a kidney tonic in China
[43]. The Japanese customary cure Sairei-to, a
12-herb blend, has likewise been observed to
be renal protective [44]. Concentrates from the
base of Salvia miltiorriza along with fructose
1-6 diphosphate forestalled the decay of renal
cortical Na-K-ATPase movement prompted by
ischemia and gentamicin in rats [45].
Concentrates of the plant Herniaria hirsute
restrain calcium oxalate gem collection and in
this way might be valuable in preventing renal
calculi formation [46]. Notwithstanding,
comparable advantages when exhibited in
human investigations will characterize the spot
of homegrown medications in
nephroprotection. Taking everything into
account, the standards of Ayurveda were
articulated quite a while back and it depends on
great logical proof, yet as of late, research
should be put and incorporation with the
cutting edge arrangement of medicines is
required to clear the path for a proof-based .
Home grown prescription is easy and beneficial
but their impact on health long term using
should be studied.
Homegrown prescription is easy and
advantageous to health but their impact on
health after using long term should be studied,
particularly among the rustic people groups.
The genuine frequency of CKD, because of
nephrotoxic herbs stays questionable. It is
realized that people with or in danger of renal
brokenness might be especially defenceless to
the unsafe impacts of regular items, either
through renal intricacies related with some
regular items or because of the aggregation of
the common item optional to diminished renal
leeway. They include acute tubular necrosis,
acute interstitial nephritis, hypokalemia,
Fanconi's syndrome, chronic interstitial
nephritis, hypertension, papillary necrosis,
nephrolithiasis, urinary retention, and cancer
of the urinary tract (Table 1).
Table 1: Herbal Medicines and Chronic Kidney Disease [33].
Plant species
Common Name
Toxic Compound
Manifestation
References
1. Aristolochia spp.
Aristolochic acid
Chronic interstitial nephritis, renal
tubular defects, urothelial malignancies
[13,14]
2. Larrea tridentata
Chapparal
Nordihydroguaiaretic
acid
Renal cysts, renal cell carcinoma
[32,33]
3. Ephedra sinica
Ma-Huang,
ephedra
Ephedrine
Nephrolithiasis, obstructive nephropathy
[34]
4. Pithecolobium
lobatum, P. jiringa
Django
Djenkolic acid
Nephrolithiasis, obstructive nephropathy
[15,16]
5. Averrhoa carambola
Starfruit
Oxalic acid
Nephrolithiasis, obstructive nephropathy
[25]
6. Vaccinium
macrocarpon
Cranberry
Oxalic acid
Nephrolithiasis, Obstructive nephropathy
[35]
7. Glycyrrhiza glabra
Liquorice
Glycyrrhizin
Hypokalaemic nephropathy
[33,36]
8. Salix daphnoides
Willow Bark
Salicin
Renal papillary necrosis
[37]
9. PausinystaliaYohimbe
Yohimbe
Yohimbine Lupus
Lupus nephritis
[30,33]
10. Fucus vesiculosus
Bladder wrack
Heavy metals
(contaminant)
Chronic interstitial nephritis
[38]
11. Rhizoma Rhei
Rhubarb
Anthraquinone
Chronic interstitial nephritis
[39]
12. Echinacea spp.
Coneflower
Arabinogalactan
Renal tubular acidosis
[40]
Nephrotoxic Effect of Herbal Medicine Maurya Neelesh Kumar
RRJoT (2019) 28-35 © STM Journals 2019. All Rights Reserved Page 33
CONCLUSION
Herbal products are usually seen as sheltered
and successful options, in contrast, to remedy
as well as non-professionally prescribed
medicines. The absence of institutionalized
approaches and guidelines muddles the
utilization of common items. Nonetheless, it is
basic that patients grasp the potential threats
related to devouring characteristic items,
particularly when managed without conference
with human services proficient. Herbal
medicine may be a risk for the kidneys.
Various renal syndromes were reported after
the use of medicinal plants. Herbal medicine
also may be hazardous for renal patients
because it may interact with such drugs or
medicines as cyclosporine or carry significant
amounts of potassium. The person should be
counsels with the practitioner, nutritionist,
pharmacist and/or product manufacturer and
take complete information regarding safety,
dosage, duration of use, interactions with
prescription drugs, etc. Use only standardized
herbal extracts made by reputable companies.
Never take more than the recommended
dosage, or longer than recommended. Do not
use herbal remedies for serious illness. Do not
use herbs if considering pregnancy. Keep in
mind, natural does not mean safe, especially
for CKD patients. Be smart and ask questions
before using any herbal products. The aim is to
provide more precise information on herbal
medications along with more rigorous
regulations regarding the proper identification
of the herb in question prior to harvesting,
processing, storage, packaging, marketing and
advertising, appear obligatory, in order to
safeguard the consumers’ health interests and
optimise the safety of these products.
CONFLICT OF INTEREST
The author states that there is no conflict of
interest regarding the material discussed in the
manuscript.
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Cite this Article
Neelesh Kumar Maurya. Nephrotoxic
Effect of Herbal Medicine and
Supplements: A Review. Research &
Reviews: A Journal of Toxicology. 2019;
9(2): 28–35p.
