title: Andrographolide induced acute kidney injury: analysis of 26 cases reported in Chinese Literature.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Nephrology, PLA 309th Hospital (General Hospital of PLA General Staff Department), Beijing, China.
authors.forename: Wu-Xing
authors.initials: WX
authors.lastname: Zhang
authors.forename: Zhi-Min
authors.initials: ZM
authors.lastname: Zhang
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004224:Diterpenes / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged
chemical_list: D004224:Diterpenes; C030419:andrographolide
keywords: acute kidney injury; acute tubular necrosis; andrographis paniculata; andrographolide; traditional Chinese medicine