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Nephrotoxicity and Medicinal Plants
Research Guide
What is Nephrotoxicity and Medicinal Plants?
Nephrotoxicity and Medicinal Plants is the study of renal toxicity caused by compounds like aristolochic acid in certain Chinese herbs, leading to nephropathy, urothelial carcinoma, and acute interstitial nephritis.
This field examines the health effects of aristolochic acid from herbal remedies, including renal toxicity, DNA adduct formation, mutation signatures, and carcinogenicity. A total of 21,843 papers address this topic, though 5-year growth data is unavailable. Key concerns involve rapidly progressive interstitial renal fibrosis and high prevalence of urothelial carcinoma in affected patients.
Topic Hierarchy
Research Sub-Topics
Aristolochic Acid Nephropathy
This sub-topic examines the tubulointerstitial fibrosis and rapid progression to end-stage renal disease from aristolochic acid exposure. Researchers study histopathological patterns, biomarkers, and clinical outcomes in affected cohorts.
Aristolochic Acid DNA Adducts
This sub-topic investigates aristolactam-DNA adduct formation, persistence, and detection methods in renal tissues. Researchers develop mass spectrometry assays and correlate adduct levels with exposure duration.
Aristolochic Acid Mutational Signature
This sub-topic analyzes the A:T→T:A transversion mutational signature in urothelial carcinoma genomes. Researchers apply whole-genome sequencing to trace environmental exposures across global patient populations.
Urothelial Carcinoma Aristolochic Acid
This sub-topic explores aristolochic acid-induced upper urinary tract and bladder cancers. Researchers correlate herbal remedy histories with tumor mutation burdens and survival prognoses.
Herbal Medicine Nephrotoxicity
This sub-topic assesses renal adverse effects beyond aristolochic acid in traditional Chinese and Ayurvedic remedies. Researchers conduct pharmacovigilance studies and toxicological screening of polyherbal formulations.
Why It Matters
Aristolochic acid in Chinese herbs like Aristolochia fangchi has caused outbreaks of nephropathy and urothelial carcinoma, notably in young women using slimming regimens, as shown in 'Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs' (Vanherweghem et al., 1993) where cases linked to herbal use emerged. 'Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)' (Nortier et al., 2000) reported a high prevalence of urothelial carcinoma among patients with end-stage Chinese-herb nephropathy. 'Aristolochic acid nephropathy: A worldwide problem' (Debellé et al., 2008) highlights its global persistence, informing regulatory bans on aristolochic acid-containing remedies and safer herbal medicine practices in nephrology.
Reading Guide
Where to Start
'The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety' (Ekor, 2014) is the starting point for beginners because it provides broad context on herbal medicine safety issues, including nephrotoxicity risks, with 3611 citations.
Key Papers Explained
'Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs' (Vanherweghem et al., 1993, 1060 citations) first identified Chinese herb links to rapid fibrosis, setting the stage for 'Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)' (Nortier et al., 2000, 967 citations), which demonstrated high carcinoma prevalence from Aristolochia fangchi. 'Aristolochic acid nephropathy: A worldwide problem' (Debellé et al., 2008, 739 citations) builds on these by outlining global epidemiology and mechanisms like DNA adducts.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Research centers on aristolochic acid's mutation signatures, DNA adduct persistence, and worldwide nephropathy cases, as detailed in 'Aristolochic acid nephropathy: A worldwide problem' (Debellé et al., 2008). No recent preprints or news in the last 12 months indicate steady focus on established mechanisms without new breakthroughs.
Papers at a Glance
| # | Paper | Year | Venue | Citations | Open Access |
|---|---|---|---|---|---|
| 1 | The growing use of herbal medicines: issues relating to advers... | 2014 | Frontiers in Pharmacology | 3.6K | ✓ |
| 2 | Rapidly progressive interstitial renal fibrosis in young women... | 1993 | The Lancet | 1.1K | ✕ |
| 3 | Urothelial Carcinoma Associated with the Use of a Chinese Herb... | 2000 | New England Journal of... | 967 | ✓ |
| 4 | Tubulointerstitial Changes as a Major Determinant in the Progr... | 1992 | American Journal of Ki... | 964 | ✕ |
| 5 | The analysis of onion and garlic | 2006 | Journal of Chromatogra... | 922 | ✕ |
| 6 | UROTHELIAL CARCINOMA ASSOCIATED WITH THE USE OF A CHINESE HERB... | 2014 | — | 815 | ✕ |
| 7 | Extended-spectrum beta-lactamases | 1989 | Antimicrobial Agents a... | 774 | ✓ |
| 8 | Aristolochic acid nephropathy: A worldwide problem | 2008 | Kidney International | 739 | ✕ |
| 9 | An interdisciplinary approach to the care of patients with Weg... | 2000 | Arthritis & Rheumatism | 694 | ✕ |
| 10 | Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease | 2016 | JAMA Internal Medicine | 688 | ✓ |
Frequently Asked Questions
What is aristolochic acid nephropathy?
Aristolochic acid nephropathy is a form of renal fibrosis and failure caused by aristolochic acid from certain Chinese herbs like Aristolochia fangchi. 'Aristolochic acid nephropathy: A worldwide problem' (Debellé et al., 2008) describes it as a global issue involving tubulointerstitial damage. It leads to end-stage renal disease and urothelial carcinoma.
How does aristolochic acid cause kidney damage?
Aristolochic acid forms DNA adducts, creating mutation signatures that drive renal toxicity and carcinogenesis. 'Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)' (Nortier et al., 2000) links it to high urothelial carcinoma rates in Chinese-herb nephropathy patients. This process underlies acute interstitial nephritis and progressive fibrosis.
What are the main adverse effects of herbal medicines?
Herbal medicines pose risks of adverse reactions, including nephrotoxicity from aristolochic acid. 'The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety' (Ekor, 2014) notes over 80% of the world relies on them for primary healthcare, complicating safety monitoring. Chinese herbs exemplify challenges with renal fibrosis and carcinoma.
Which herbs are linked to nephropathy?
Aristolochia fangchi is a key Chinese herb associated with nephropathy and urothelial carcinoma. 'Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs' (Vanherweghem et al., 1993) ties slimming regimens containing it to rapid fibrosis in young women. It exemplifies risks in unregulated herbal products.
What is the prevalence of urothelial carcinoma in Chinese-herb nephropathy?
Patients with end-stage Chinese-herb nephropathy from aristolochic acid show high urothelial carcinoma prevalence. 'Urothelial Carcinoma Associated with the Use of a Chinese Herb (Aristolochia fangchi)' (Nortier et al., 2000) documents this association directly. It underscores the carcinogenic potential of these herbs.
Open Research Questions
- ? How do DNA adducts from aristolochic acid specifically contribute to mutation signatures in urothelial carcinoma?
- ? What mechanisms drive rapidly progressive interstitial renal fibrosis from Chinese herb exposure?
- ? Can early biomarkers detect aristolochic acid-induced acute interstitial nephritis before end-stage disease?
- ? What dose-response relationships exist between aristolochic acid exposure and nephropathy progression?
- ? How prevalent is aristolochic acid nephropathy in current global herbal medicine users?
Recent Trends
The field maintains focus on aristolochic acid's role in nephropathy from Chinese herbs, with classics like 'The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety' (Ekor, 2014, 3611 citations) underscoring monitoring challenges amid 80% global reliance.
No recent preprints or news in the last 6-12 months reported, and 5-year growth data unavailable for 21,843 papers.
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