Acute Kidney Injury Associated with Hepato-protective Chinese Herb - Pien Tze Huang

The Chinese herbal formula, Pien Tze Huang, is popular in Asian countries and the United States for its hepato-protective effects. This report concerns two patients who took Pien Tze Huang, and who initially exhibited polyuria, followed by weight loss and an acute kidney injury. When the patients stopped taking Pien Tze Huang, and was given with intravenous normal saline, the renal function gradually recovered. The main component of Pien Tze Huang is Panax notoginseng that has a diuretic effect in animal studies. In the first patient, the patient received larger than the normal dosage. The possibility of heavy metal induced nephropathy was excluded by the history, and no aristocholic acid levels were detected in their blood. Besides, a normal renal biopsy excluded acute tubulo-interstitial injury. However, these two patients were diagnosed as having prolonged prerenal azotemia by a low percentage of fraction of sodium excretion in Patient 1, and a high urine gravity in Patient 2. We believed that we should be alert to any adverse effects of Chinese herbs, which are usually thought to be healthy and harmless to human body. The cautious usage of this kind of remedy and supervision by well-trained professionals are mandatory.