Andrographolide induced acute kidney injury: analysis of 26 cases reported in Chinese Literature.

IF 1.9
Wu-Xing Zhang, Zhi-Min Zhang, Zhi-Qiang Zhang, Yang Wang, Wei Zhou
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引用次数: 17

Abstract

Aim: Some Chinese herbs have been known for their kidney toxicity. Andrographolide, the primary component of a traditional medicinal herb, Andrographis paniculata, is widely used in China for the treatment of upper and lower respiratory tract infection, and dysentery etc. The aim of the study was to identify and summarize any case of kidney injury attributed to its use in the Chinese literature.

Methods: A systemic analysis of the Chinese literature from January 1978 to August 2013 was conducted of case reports of andrographolide induced acute kidney injury (AKI).

Results: We identified 26 cases of andrographolide induced AKI (22 males and four females), with an average age of 31.3 years (range: 21 months to 47 years). 100-750 mg (58% 500 mg) of andrographolide was administered in 100-500 mL 5% glucose solution or normal saline by intravenous drip once a day. The adverse event appeared after one to six doses (19 [73.1%] patients got only one dose; cumulative dose 690 ± 670 mg) of andrographolide was given, or 0-96 h (median 1 h) after andrographolide was given. The symptoms included flank pain in 23 cases (88.5%), decreased urine volume in five cases (19.2%), and nausea or vomiting in six cases (23.1%). Laboratory tests showed maximum creatinine 352.8 ± 184.1 (158-889) μmol/L and blood urea nitrogen 12.1 ± 7.6 (4.0-40.6) mmol/L. Urine analysis showed proteinuria in 10 (38.5%) cases and occult blood in eight (30.8%) cases. Kidney biopsy was carried out in two cases and both revealed acute tubular necrosis. Management of this adverse event included withdrawal of the culprit drug, conservative therapy, and renal replacement therapy (six cases, 23.1%). All the patients recovered and were discharged with a normal or close to normal serum creatinine. Their average length of hospital stay was 12.1 ± 4.8 days.

Conclusions: Acute kidney injury may occur shortly after intravenous infusion of andrographolide, with symptoms including flank pain, decreased urine output, and nausea or vomiting. The pathological change might be acute tubular necrosis. Renal replacement therapy may be needed in some patients and with a good recovery rate. The mechanisms of andrographolide induced AKI need to be further studied.

穿心莲内酯致急性肾损伤26例文献报道分析。
目的:一些中草药以其肾毒性而闻名。穿心莲内酯是传统中药穿心莲的主要成分,在中国广泛用于治疗上、下呼吸道感染、痢疾等。本研究的目的是识别和总结中国文献中因其使用而引起的任何肾损伤病例。方法:对1978年1月至2013年8月中国文献中有关穿心莲内酯所致急性肾损伤(AKI)的病例报告进行系统分析。结果:我们确定了26例穿心莲内酯诱导的AKI(男性22例,女性4例),平均年龄31.3岁(范围:21个月至47岁)。穿心术内酯100-750 mg (58% -500 mg)加入100-500 mL 5%葡萄糖溶液或生理盐水中静脉滴注,每日1次。1 ~ 6次给药后出现不良事件(19例[73.1%]患者仅给药1次;给予穿心莲内酯累计剂量(690±670 mg),或给药后0 ~ 96 h(中位1 h)。症状包括腹部疼痛23例(88.5%),尿量减少5例(19.2%),恶心或呕吐6例(23.1%)。血尿素氮12.1±7.6 (4.0 ~ 40.6)mmol/L,血肌酐352.8±184.1 (158 ~ 889)μmol/L。尿分析显示蛋白尿10例(38.5%),隐血8例(30.8%)。两例肾活检均显示急性肾小管坏死。该不良事件的处理包括停药、保守治疗和肾脏替代治疗(6例,23.1%)。所有患者均康复出院,血清肌酐正常或接近正常。平均住院时间为12.1±4.8天。结论:静脉输注穿心莲内酯后不久可发生急性肾损伤,症状包括腰痛、尿量减少、恶心或呕吐。病理改变可能为急性肾小管坏死。一些患者可能需要肾脏替代治疗,并且恢复率很好。穿心莲内酯诱导AKI的机制有待进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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