Prospective Analysis of Self Medication With Phytotherapy in Nephropatic Patients.

The use of traditional medicine is widespread globally. In Africa, the prevalence is estimated at 60%, while usage in developing countries may reach 80%. Phytotherapy is defined as the treatment or prevention of diseases using plants; it plays a role in both traditional medicine and the current "modern" market. Chronic kidney disease (CKD) is one of the most common chronic conditions worldwide, with over 800 million prevalent cases. Its prevalence is steadily rising, affecting high-income and low-to-middle-income countries alike. Patients with kidney disease may be heavily exposed to phytotherapy.

Phytotherapy has long been used to treat kidney disease, and the kidneys are a primary route for the elimination of plant-derived compounds and their metabolites. While some plants appear to possess nephroprotective properties, others may cause acute kidney injury, chronic kidney disease, kidney stones, Fanconi syndrome, or urothelial cancers. Patients with chronic kidney disease may be at particular risk of nephrotoxicity due to reduced nephron mass and polypharmacy.

Currently, there is very little data regarding the use of phytotherapy among patients with chronic kidney disease, or concerning its protective or toxic effects.

In Réunion, there is a strong culture of phytotherapy-known as *z'herbages* in Réunionese Creole. Réunion is also the French department with the highest prevalence of end-stage renal disease. Patients with chronic kidney disease in Réunion may frequently use phytotherapies-whether for renal or systemic purposes-the consequences of which remain unknown. There is therefore a clear need to map these practices in order to identify candidate plants with potential nephroprotective or nephrotoxic effects.