Researchers at King’s College London are calling for scientists and doctors across the world to work together to prevent kidney injury caused by botanicals - which are drugs or food made from plants.

Published in the World Journal of Traditional Chinese Medicine and with Kidney Research UK funding, the team has developed a framework for a new database to promote safe use of botanicals across the world.

Beneficial to health, but not without risk

Botanicals are used widely in traditional medicine and have demonstrated benefits in a variety of conditions, including where conventional medicine has failed.

But despite these medical benefits, some of them can also cause problems such as kidney damage or further damage to the kidneys in patients with existing kidney problems – this is known as botanical-induced kidney injury (BIKI).

BIKIs are like adverse drug reactions (ADRs), but we don’t fully understand their scale and severity. There are some well established examples, such as plants containing aristolochic acids (AA) which can cause kidney damage and bladder cancers, where there are robust criteria for diagnosing AA-induced damage.

And while the World Health Organization (WHO) maintains an international system for monitoring ADRs, no such system for monitoring and measuring BIKIs exists.

Understanding the effects of botanicals on kidneys

In this new research, Dr Qihe Xu and colleagues at King’s College London have developed a framework for categorising the different ways BIKIs are caused and how it is seen in patients. Dr Xu and his team believe their system will create the basis for a well-structured database of BIKI, with the aim of promoting safe use of botanicals worldwide.

Dr Xu said: “Twelve years ago, I received funding from Kidney Research UK to investigate the pharmacological and toxicological activities and mechanisms of plant-based therapies, the first grant of its kind in the UK as far as I knew. The activities observed and the complexity encountered encouraged me to dig deeper, leading to an EU-funded international collaboration, and a new initiative at King’s aiming at integrating wisdom from the East and the West to develop tomorrow’s medicine.”

The research team say there are four ‘cause categories’ of BIKI, including general toxicity of the plant, individual responses, cumulative and delayed onset (for example, the potential to cause cancer in the future), or when DNA is damaged. They also describe six ways the injury presents itself, including acute kidney injury, kidney stones, damage or changes to the tubules of the kidney, damage to the glomeruli (where blood is filtered in the kidney), chronic kidney disease and kidney or bladder cancers.

The researchers now hope their classification system will be used to document characteristics, mechanisms and evidence of kidney injury associated with botanical use. By adding this to other databases and drug reaction monitoring programmes, an international monitoring system can be set up for BIKI, like the ADR system set up by the WHO.

A call to action – to invest and collaborate

As a nephrologist for thirty years, Dr Xu wants to draw attention to the potential benefits and pitfalls plant-derived drugs and food could bring about to kidney care.

“I want to urge more investment and collaboration in this emerging area of research,” he explains. “This has become all the more urgent. European regulators have regulated more and more botanicals as herbal medicinal products since 2004, meanwhile with globalisation, more and more non-European botanicals have been widely used in Europe and have been entering our market. I hope that the framework we have developed has laid a solid foundation for further development along this important frontier.”

Once established, such a database may be linked with electronic patient records and monitoring systems. This would generate alerts, guide clinical decision-making, direct future research, and support evidence-based regulation of herbal medicines and education of healthcare professionals and the public.

Finally, to prevent BIKI, the researchers say the collaboration needs to involve patients and other stakeholders.

Find out more.