Can ginseng cause severe renal dysfunction?/nAn 86 year-old man was admitted to the hospital for se

Fråga: Can ginseng cause severe renal dysfunction? An 86 year-old man was admitted to the hospital for severe renal dysfunction. Creatinine was 687 umol/L. The patient has self-medicated with ginseng extract for six years and has not had any earlier problems of this kind. He is not taking any other drugs. Sixteen years ago he was operated for prostatic cancer but has no physical problems from this that might be the cause of his condition according to his physician.

Sammanfattning: The documentation of renal dysfunction after treatment with ginseng extracts is scarce. One published case report of diuretic resistance in a man with renal dysfunction and three case reports in WHO adverse reactions database of urinary system disorders were found. However, in the diuretic resistant case germanium in the ginseng extract is suspected to be the causing agent. Two animal studies do not provide evidence that ginseng extracts are nephrotoxic. In this case we cannot role out the ginseng extract as the causing agent, but there are several influencing factors such as high age and prostatic cancer that may have contributed. In addition, previous renal function is unknown and no results from renal biopsy are available.

Svar: A thorough literature search in Medline, Embase, Drugline, Swedis and other pharmacological literature sources have only revealed scarce documentation of ginseng induced renal dysfunction. Ginseng is a natural remedy containing several ginsenoids, which are thought to be the pharmacological active components, reported to reduce fatigue, enhance physical and mental capacity and enhance the natural resistance and recuperative power. Adverse effects are uncommon and the most frequently observed are gastrointestinal disturbances (diarrhea, nausea), insomnia, skin eruptions and hypertension (1-5).

One case report was found, where a 63-year-old man developed diuretic resistance with edema and hypertension after 10 days of treatment with a ginseng preparation containing germanium. The patient had been treated with furosemide and cyclosporin for membranous glomerulonephritis for several years. When, ginseng was discontinued and diuretics were given, he rapidly recovered. On the day following discharge, he restarted his nutritional treatment with ginseng and a positive rechallenge was observed. In this case the metalloid germanium was suspected to be the causing agent rather than the ginseng component of the extract (6).

No licensed herbal medicine in Sweden contains germanium. However, non - licenced ginseng - containing extract are on the market in Sweden but no list of their contents, is compiled and available (7,8). In the present case it is not known which ginseng preparation the patient used and it can not excluded that germanium was present in that extract.

There are totally three reports in the WHO adverse reactions database on ginseng induced urinary system disorders, (nocturia, pyuria and abnormal renal function, respectively) (9). It should be noted that the WHO database does not include a homogeneous evaluation of reported cases due to differences among reporting countries.

Two studies in nephrectomized and cisplatin induced renal failure rats treated with ginseng extract did not provide any evidence for renal toxicity (10,11).

We recommend this case to be reported to the regional centre of the Swedish adverse drug reaction advisory committee (SADRAC).