Supplementary Table 1 Traditional medicines and edible plants associated with acute kidney injury.
Common name (latin
name)
Countries
where adverse
effects reported
Indication or purported
property
Toxic compound
or metabolite
Types of renal injury
reported
Other adverse events
reported
Outcomes
Alfalfa (Medicago sativa)1
US, Slovenia
Arthritis
L-canavanine
Severe transplant
rejection (when taken
with black cohosh)a
Hyperkalemia
Partial improvement of
renal function with antirejection therapy
Autumn crocus (Colchicum
autumnale)2–4
Turkey
Gout
Colchicine
AKI
Hemorrhagic gastritis,
vascular injury, paralysis,
multiorgan failure
Death (in severe cases)
Bird flower (Crotalaria
laburnifolia)5–7
Zimbabwe, Sri
Lanka
Dysmenorrhea, to
induce abortion
Pyrrolizidine
alkaloids
ATNa, hepatorenal
syndrome
Hepatic veno-occlusive
disease, pulmonary injury,
thrombocytopenia
Death or recovery
Black cohosh (Actaea
racemosa)1,8,9
US
Menopausal symptoms,
anti-inflammatory
Serotonin receptor
agonist
Transplant rejection
(when taken with
alfalfa)a
Hepatotoxicity
Partial improvement of
renal function with antirejection therapy
Cape aloe (Aloe
capensis)10–13
South Africa
Constipation, insect
bites
Oxidative
degradation
products
ATN,
parenchymatous
nephritisa
Severe vomiting,
hypotension
Improvement of renal
function after temporary
dialysis
Cat’s claw (Uncara
tomentosa)10,14,15
Peru
Arthritis, cirrhosis,
gastritis, female
reproductive tract
cancers
Alkaloids, flavonols
AIN (in a patient with
lupus)a
Diarrhea, hypotension,
bruising, bleeding gums
Improvement of renal
function with
discontinuation of remedy
Chelation therapy16
Ireland
Coronary artery disease
Ethylenediaminetet
ra-acetic acid
ATNa
Fever, hypotension,
nausea, vomiting, bone
marrow suppression
Slow improvement of renal
function on dialysis
Chinese yew (Taxus
celebica)17
Asia
Diabetes
Flavonoid
(sciadopitysin)
ATN, AIN
Hepatitis, hemolysis,
disseminated intravascular
coagulation
Death, or improvement of
renal function after dialysis
Chromium picolinate14,18–20
US
Diabetes, to induce
weight loss
Chromium
ATN, AIN, ‘heavy
metal nephropathy’a
Hemolysis,
thrombocytopenia, liver
Improvement of renal
function after dialysis
dysfunction
CKLS (Colon, kidney, liver,
spleen purifier; contains
Aloe vera, Cascara
sagrada, Larrea tridentata
and Arctostaphylos uvaursi)21
US
Purification
Unknown
AINa
Diarrhea, hematuria
Improvement of renal
function with dialysis
Cone flower
(Echinacea)10,22,23
Australia, US
Fever, immunostimulant,
antiseptic, to enhance
digestion
Compound that
might elicit crossreactivity with other
allergens;
pyrrolizidine
alkaloid
contaminants
(possibly)
AKI, renal tubular
acidosis, hypokalemia
Urticaria, anaphylaxis,
nausea, vomiting,
hypertension, activation of
auto-immune disease (e.g.
Sjogren’s syndrome)
Improvement of renal
function on cessation of
remedy
Creatine14,24,25
US
Muscle disorders, body
building
Creatine
monohydrate
AINa
Hypertension,
rhabdomyolysis
Death, or improvement of
renal function with dialysis
Djenkol beans, jering
(Pithecolobium
lobatum)3,26–28
Malaysia
Traditional delicacy
Djenkolic acid
ATNa, obstructive
nephropathy
Djenkolism: nausea,
vomiting, loin pain, gross
hematuria, oliguria
Improvement of renal
function with treatment,
ureteric stenting or
cessation of remedy
Fish gallbladder
(Cyprinidae: Grass carp,
common carp, silver carp,
black shark fish, bonylipped barb fish)2,29–32
Taiwan,
Vietnam, Japan,
China
Arthritis, impotence, to
enhance visual acuity
5-alpha-cyprinol
ATNa
Nausea, diarrhea,
vomiting, toxic liver failure,
multiorgan dysfunction
Death, or improvement of
renal function with dialysis
Glucosamine33
UK
Arthritis
Glucosamine itself
AIN
Gastrointestinal symptoms,
insulin resistance
Improvement of renal
function after dialysis and
steroid treatment
Hemlock (Conium
maculatum)34–36
Italy, US
Not used as a remedy,
but has been ingested
accidentally via
consumption of
contaminated fowl, or in
cases of poisoning
Cicutoxin, coniine
ATN
Rhabdomyolysis,
neurotoxicity
Death
Hydrazine sulfate37,38
Finland, US
Cancer
Hydrazines
AKI, hepatorenal
syndrome
Multiorgan failure,
hepatotoxicity
Death
Impila, ox-eye daisy
(Callilepis laureola)3,39–42
North and South
Africa,
Mediterranean
Impotence, evil spirits,
gastrointestinal
complaints
Atractyloside
ATNa, hepatorenal
syndrome
Hyperkalemia,
convulsions, stupor, liver
failure
Death (in most cases)
Khat leaf (Catha edulis)3,43
East Africa,
Yemen
Stimulant
S-cathionone,
norephedrine, Dnorpseudoephedrin
e
ATNa
Hepatotoxicity,
hypertension, myocardial
infarction
Improvement of renal
function with cessation of
remedy
Licorice (Glycyrrhiza
glabra)3,10,14,44,45
Worldwide
Sore throat, cough,
arthritis, to induce
weight loss
Glycyrrhetinic acid,
glycyrrhizic acid
ATN secondary to
rhabdomyolysis from
hypokalemia,
hypokalemic
nephropathy,
Fanconi’s syndrome
Amenorrhea,
pseudoaldosteronism,
hypertension, heart failure,
rhabdomyolysis
Improvement of renal
function with cessation of
remedy
Ma huang (Ephedra
sinica)46–50
US
To induce weight loss, to
cause sexual arousal
Ephedrine,
norephedrine and
pseudoephedrine
Nephrolithiasis, AKI
secondary to
rhabdomyolysis
Dermatitis, anxiety,
restlessness, psychosis,
myocardial infarction,
stroke, hypertension
Recovery with dialysis
Mourning cypress
(Cupressus funebris)51
Taiwan
Not used as a remedy,
but has been taken
mistakenly instead of
yew
Flavonoids
ATN, AINa
Autoimmune hemolytic
anemia, liver injury
Improvement of renal
function after dialysis and
cessation of remedy
Mushrooms (Amanita
phalloides, Cortinarius
spp)3
Worldwide
Food
Phallotoxins,
amatoxins
Necrosis a
Shock, liver failure
Death
Oduvan (Cleistanthus
collinus)44,52,53
India
Cancer, to induce
abortion, to induce
suicide, to cause
poisoning
Arylnaphthalene
lignan lactones
AKI
Severe hypokalemia,
arrhythmias, muscle
weakness, hypotension,
liver failure, metabolic
acidosis
Death
Pennyroyal (Hedeoma
pulegiodes)54–56
US
Colic, to induce abortion,
to stimulate
menstruation
Pulegone,
menthofuran
Edematous
hemorrhagic kidneys,
ATNa, hepatorenal
Seizures, liver failure,
altered mental status,
Metabolic acidosis
Death, or survival after a
prolonged illness
syndrome
Potassium dichromate57,58
South Africa
Purging
Hexavalent
chromium
ATN
Diarrhea, dehydration,
colonic perforation (from
rectal administration),
gastrointestinal
hemorrhage, liver
dysfunction
Death, or partial renal
recovery after dialysis
Propolis59
Brazil, Taiwan
Inflammation, cancer
Unknown (contains
>300 substances)
AIN
Contact dermatitis, allergy
Improvement of renal
function after cessation
and dialysis; recurrence on
re-challenge
Rhubarb (Rhizoma
rhei)2,10,60
Hong Kong
Laxative, antiinflammatory
Anthraquinones,
oxalic acid
Interstitial fibrosisa,
albuminuria, kidney
stones
Hepatitis, hypokalemia
Improvement of renal
function with cessation of
remedy
Sheep bile61
Saudi Arabia
Diabetes mellitus
Bile acids
AKI
Nausea, vomiting,
hepatitis, coma
Resolution on cessation of
remedy
Skin lightening creams62,63
Kenya, Malawi
Skin lightening
Amino-mercuric
chloride
Minimal change
disease, membranous
nephrotic syndromea
Edema
Regression of disease with
cessation of remedy
Sobi-lobi (Datura spp)64
Niger
Hallucinogen
Anticholinergic
alkaloid esters
Acute urinary
retention, ureteric
spasm
Atropine-like effects
(hallucinations, delirium,
mydriasis, coma)
Resolution. Response to
physostigmine.
Spanish fly, blister beetle
(Lytta vesicatoria)65
Africa, US
Sexual stimulation, wart
removal
Cantharidin
ATNa, glomerular
injury, proteinuria,
renal hemorrhage
Seizures, gastrointestinal
hemorrhage, tachycardia
Death, or improvement of
renal function with
supportive care
Spurge (Euphorbia
matabelensis)5
Zimbabwe
To induce abortion
Irritant chemicals in
the latex of the
plant
AKI
Thrombocytopenia
Death
St John’s wort (Hypericum
perforatum)16,66
US
Depression,
inflammation, gout, skin
lacerations
Hyperforin
(stimulates
cytochrome P450
enzymes)
Acute transplant
rejection (remedy
reduces blood
ciclosporin levels)a
Dermatitis, constipation
Graft loss (in some cases)
Star fruit (Averrhoa
carambola)67–69
Hong Kong,
Taiwan
Food; taken undiluted as
a remedy for hangovers
Oxalate
Oxalate
nephropathya, tubular
obstruction
Hyperkalemia, confusion,
hiccup, vomiting
Improvement of renal
function after dialysis
Takaout Roumia46
Morocco, Sudan
Hair dye (used instead
of Takaout El Badia,
Tamarix orientalis)
Paraphenylenedia
mine
ATN
Rhabdomyolysis
Death (often)
Thunder God Vine, Lei
Gong Teng (Tripterygium
wifordii)70
Taiwan
Arthritis, antiinflammatory,
immunosuppressant
Unknown (possibly
the active moiety
triptolide)
AKI
Hypovolemic shock
Death
Ting Kung Teng (Erycibe
henryi)71
Taiwan
Pain
Cholinergic tropane
alkaloids
AKI
Vomiting, diarrhea,
weakness, hypersalivation,
hypotension, hypothermia
Resolution
Wild wisteria, violet tree
(Securidaca
longepedunculata)3,5
Congo, Zambia,
Zimbabwe
Dysmenorrhea, venereal
diseases, to induce
abortion, to induce
suicide
Methylsalicylate,
securinine
Cortical necrosisa,
ATN
Diarrhea, dehydration,
collapse
Death
Wormwood oil (Artemisia
absinthium)72
US, Europe
To stimulate digestion
Terpene
Rhabdomyolysis, ATN
Nausea, vomiting,
seizures, metabolic
acidosis, heart failure,
‘absinthism’, red urine
Improvement of renal
function with supportive
therapy
Yam (Discorea
quartiniana)3
Africa, Asia
Taken as food, to cause
poisoning or to induce
suicide
Dioscorine,
dioscine (if
prepared
improperly)
AKI
Central nervous system
irritability, liver failure
Death if inadequate
supportive care
Yellow oleander (Thevetia
peruviana)14,73–75
India, Sri Lanka
To induce suicide
Cardiac glycosides
ATN, glomerular
vacuolationa
Hepatitis, multiorgan
failure, mydriasis,
bradycardia, arrhythmias
Death, or recovery after
dialysis
Yohimbe (Pausinystalia
yohimbe)76
US, West Africa
Impotence
Yohimbine
AKI
Lupus-like syndrome
Improvement of renal
function with corticosteroid
treatment
Abbreviations: AIN, acute/allergic interstitial nephritis; AKI, acute kidney injury; ATN, acute tubular necrosis. aDiagnosis made by histology and/or autopsy.
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