Patients with chronic renal failure or on renal-replacement therapies may consider the use of herbal medicines.

In recent years, people have become more familiar with alternative therapies and are increasingly trying them, on a self-selection basis, to either replace or complement conventional medication. Unsurprisingly, therefore, we have seen an increase in their availability as over-the-counter home remedies.

Unfortunately, there is often a misplaced perception by patients that herbal remedies are safe as they are natural. Although there is a lack empirical data, there are many anecdotal reports of patients admitted with acute renal failure secondary to the use of herbal remedies.

At present, the licensing laws governing herbal medicines are limited. So, too, is the availability, both to patients and healthcare professionals, of information regarding the adverse effects and contraindications of herbal products.

Often patients choosing to take herbal remedies do not inform their nurse, pharmacist or doctor. This increases the potential for both drug-herb and herb-herb interactions.

There is rarely a professional available to advise patients on the suitability and associated risks of such products if they buy them from sources such as supermarkets, health-food shops or mail-order companies.

We are not advocating that all herbal remedies should be avoided, but make the following recommendations:

		Standardisation and statutory legislation governing the licencing and marketing of these products.
		ADR reporting of adverse effects.
		Information sources established to assist healthcare professionals make informed decisions about these remedies' benefits and risks.
		Further clinical trials into the efficacy and safety of these products.

We are currently developing a database but, until it becomes widely available, here are some commonly used herbal medicines which may affect renal function.

Aristolochia		A constituent of dieting products. It is well known to cause direct kidney damage, including fatalities. This product is now banned in the UK
Asparagus		Taken for reported diuretic action and to prevent kidney stones, asparagus been reported to cause irritation of renal epithelial tissues.
Cat's Claw		Commonly taken by patients with rheumatoid symptoms. Cat's Claw has been reported to cause acute interstitial nephritis.
Cranberry Juice		Commonly recommended for treatment/prophylaxis of urinary-tract infections, cranberry juice has been implicated in the development of urinary stones.
Ginko Biloba		Believed to improve respiratory function in asthmatics, Ginko Biloba has been implicated it in lengthening bleeding time, it should be avoided in patients taking warfarin or on haemodialysis
Juniper Berry		Taken for dyspepsia, gastric/duodenal ulcers and for its diuretic action, juniper berry may cause non-specific renal damage.
St John's Wort		Commonly taken for its anti-depressive and wound-healing properties, St John's Wort is well known to interact with cyclosporin and tacrolimus, reducing efficacy and leading to potential rejection.

These are just a few of the herbal remedies that we know are of particular relevance to the care of renal patients.

 

		We intend establishing a renal database that will be accessible by clicking on nephronline.org to identify those herbal medicines which have renal-specific implications for both healthcare professionals and patients.
		If you have any anecdotal experience or documented reports of patients who have been exposed to such remedies and consequently suffered renal adverse effects, we would be interested to hear about them. (contact link) And look out for the next update of nephronline.org to view the Herbal Medicine Database