Traditional herbal preparations and acute renal failure in South West Nigeria

Fifty-three cases (36 men; mean age 30.2+/-9.5 years) of acute renal failur e (ARF) in which traditional herbal preparations were implicated were seen over a 10-year period. The preparations had been taken to treat a febrile i llness (38 cases), abdominal upset (seven cases) and for no clear reason (f ive cases). Vaginal pessaries had been used to induce abortion in two cases and for infertility in one case. The few identified plant materials includ ed leaves and bark of the mango (Mangifera indica), shoots of cashew leaves (Anacardium occidentale), paw-paw leaves (Carica papaya), lime-leaves (Cit rus aurantifolia), Solanium erianthum, Morinda lucida leaves and bark, Azad irachta indica leaves. The major presenting features were oliguria or anuri a (41); jaundice (39); and anaemia (25). Oliguria occurred 3.5 +/- 0.7 days after the ingestion of the herbs. The picture was consistent with acute tu bular necrosis in all the cases and the mechanisms were: by intravascular h aemolysis (34); hepatotoxicity (5); and presumably direct nephrotoxicity (1 4). Forty-five patients received dialysis and three deaths were recorded. T hese cases of ARF could have been prevented by proper education and awarene ss.