Renal toxic ingredients and their toxicology from traditional Chinese medicine

ABSTRACT

Introduction: There have been increasing concerns regarding adverse reactions and toxicity incidents caused by traditional Chinese medicines (TCMs), among which the nephrotoxicity is particularly worrying.

Areas covered: This review summarizes the ingredients with renal toxicity from some TCMs through searching the relevant literature published over the past two decades. Renal toxicity components from TCMs include aristolochic acids (AAS), alkaloids, anthraquinones and others. TCM renal toxicity is most commonly caused by AAS and some alkaloids. AAS mainly come from Aristolochia contorta Bunge, Aristolochia manshuriensis Kom, Clematis Chinensis Osbeck, Aristolochia cathcartii Hook. Some renal toxic alkaloids are derived from Tripterygium regelii Sprague et Takeda, Stephania tetrandra S. Moore, Strychnos nux-vomica Linn. and Aconitum carmichaeli Debx. A few kinds of anthraquinones, flavonoids, and glycosides from TCMs also cause renal toxicity. All of these renal toxicity components and their associated renal toxicity, structures and toxic mechanism are introduced in detail in this review.

Expert opinion: Given the complexity of the toxic components, a lot of work needs to be done to analyze the specific modes of action of toxic components in vivo and in vitro, in particular, to elucidate the molecular mechanism of toxicity, in order to reduce the occurrence of renal toxicity of TCM.

KEYWORDS:

• AAS
• alkaloids
• renal toxicity
• toxicology
• Traditional Chinese medicines

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Article highlights

• With the extensive usage of TCMs, many drug-induced renal injury incidents have occurred in recent years; the renal toxic ingredients of TCMs and their toxicology have received wide attention.

• The renal toxic TCMs are mainly derived from A. manshuriensis, A. cathcartii, S. nux-vomica, A. carmichaeli, Ricinus communis Linn., and Rheum officinale Baill.

• The poisonous components contain AAs, alkaloids, glycosides, and anthraquinones.

• High dose of renal toxic TCMs can cause immediate degeneration and necrosis of renal tubular epithelial cells. Long-term drug use often results in chronic renal interstitial fibrosis, leading to acute/chronic renal damage.

• A lot of work still needs to be done to analyze the nephropathy mechanism of some AAs, alkaloids, and other TCM components.

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