1. Herbal Nephropathy Thitisak Kitthaweesin MD. Department of Medicine Phramongkutklao College of Medicine งานประชุมวิชาการประจำปี ราชวิทยาลัยอายุรแพทย์แห่งประเทศไทย ครั้งที่ 21

5. Renal Syndrome in Herbal Medicine

6. ATN AIN Interstitial Renal fibrosis Stone Cancer Hypertension Electrolyte disturbance Edema Urinary retention ???

19. AAs Chinese herb 1 USA(2000) A.mollisemae Chinese herb 1 HK(2005) AAs Chinese herb 6,12,20 China(2000, 2001,2003) AAs Eczema Rx 2 UK(1999) A.pistolochia Herb mixture 1 Spain(1996) A.fangchi Slimming pills 2,2 France (1994,1998) AAs Slimming pills 9 Belgium (1993) Agents Treatment Number Country

20. Pathology Hypocellular interstitial fibrosis Tubular atrophy Predominant in superficial cortex Glomeruli relatively spared

24. Duration and Total Doses

25. Risk Factors

26. Zhu et al.

29. Star Fruit Chang et al. AJKD 35:189-193,2000 114.3 3.31 191.9 Bottled 86.1 2.97 150.7 Canned 26 34.4 56 Fresh Cl K Na

30. Case Report Chen et al. AJKD 37:418-422, 2001 Abd/back pain N/V/backache Symptoms 4 hours hours Onset 3000 mL 1600 mL Amount Sour juice from vendor Pure fresh sour, juice Form Male Male Sex 38 77 Age

32. Dilatation of renal tubules Sloughing of renal tubular cells Interstitial edema Intraluminal and intraepithelial deposition of Oxalate Crystals Birefringence under polarized light

36. Stone

42. Oxalate Food

46. Licorice ( Glycyrrhiza glabra) Glycyrrhizic acid Glycyrrhetenic acid Renal 11 β -hydroxy-steroid dehydrogenase Hydrolyzed Inhibit

47. Apparent Mineralocorticoid Excess

53. Herb-drug Interactions

56. St John’s wort Decreased concentrations in serum Cyclosporine Breakthrough bleeding Oral pills Reduced total absorption Indinavir Increased INR Warfarin Decreased AUC, decreased peak and trough of concentrations Digoxin Decreased concentrations Theophylline

57. Barone GW et al. Transplant 2001;71:239-241

60. Ginkgo Intracerebral haemorrhage Warfarin Subarachnoid haemorrhage and subdural haematoma have been reported with the use of ginkgo alone Bilateral subdural haematoma . Paracetamol and ergotamine / caffeine Ginkgolides are potent inhibitors of PAF . Spontaneous hyphema Aspirin