한약 복용과 관련된 신병증

Abstract

Herb medicines are largely prescribed in Asian countries, and are possibly responsible for renal in- sufficiency, such as chinese herbs nephropathy. To elucidate the clinical characterization of herb medi- cine-associated nephropathies in Korea, we analyzed the clinical findings of 6 patients showing renal dysfunction with the history of herb medicine inges- tion in Yonsei university Severance Hospital and Yongdong Severance Hospital, since January 1990, and the histologic findings were also evaluated. The results were as follows. 1) The patients were 2 males and 4 females, and their ages ranged from 21 to 66 years. 2) All patients had history of herb medicine ingestion for 3 days to 12 weeks. The purpose of taking medicines was for slimming in 3, better health in 2, and treatment of back pain in one pa- tient, respectively. 3) There was no oliguric patient, with one excep- tion. Serum creatinine concentration ranges from 1.4 to 3.3, except one patient with 13.9mg/dl. The amount of urinary protein excretion ranged from 288 to 1,440mg/day, except one patient with nephrotic syndrome(6.2g/day). 4) One patient showed eosinophilia(14%) on blood cell count, and 2 patients had renal glycosuria, hypophosphatemia, and hypouricemia. The serologic findings, including complement levels were within normal limits. 5) Histologic findings were diverse, acute intersti- tial nephritis in 3(associated with minimal change disease in 1), chronic interstitial nephritis in 2, and regenerating stage of acute tubular necrosis in one. 6) All patients were managed with withdrawal of the suspected drugs. Three patients had supportive treatment, and 2 patients were treated with predni- solone. One patient received dialysis. 7) Renal functions were restored in 3 patients within 3 months after discontinuation, and 2 patients maintained initial renal insufficiency without further exacerbation. One patient with severe uremia did not recover and was maintained on dialysis for 1 month. In conclusion, herb medicine can be the cause of tubulointerstitial disease, and the potential nephro- toxicity should be considered in therapy with herbal preparations. But further studies in greater number of patients and the identification of specific subs- tance causing nephropathies in herbs should be required.