Herbal products can have very similar appearances, especially between subspecies or even varieties within a same family. These can be more difficult to discern if the herb is in the dried form. This poses a great problem as different species, even if they are within the same genus, can have very different chemical constituents (28,29). Misidentification of herbs leading to inappropriate usage of a herb is a cause of morbidity and mortality among consumers. An outbreak of rapidly progressive renal failure was observed in Belgium in 1992-1993 and was related to a slimming regimen involving Chinese herbs, namely Stephania tetrandra and Magnolia officinalis (30,31). Seventy-one cases were reported in 1 month in 1994,35 of whom were on renal replacement therapy. Renal failure has been progressive in most of the cases despite withdrawal of exposure to the Chinese herbs. Renal biopsies showed an extensive interstitial fibrosis with loss of tubes, predominantly in the outer cortex. Chemical analyses ofthe Chinese herbs powdered extracts delivered in Belgium demonstrated a misidentification between Stephania tetrandra and another potentially nephrotoxic chinese herb, Aristolochia fangchi. Manufacturers of herbal products are not required to have good manufacturing practices (GMP) under the current regulations in the United States, Singapore, and many other countries. Often, consumers can choose from more than one manufacturing processes or formulations for a given herb. Each method may result in a different constituent in the final product, or a different percentage of the active compound (32,33). It is not surprising that inconsistencies in similar herbal remedies, or even between different batches of a specific herbal remedy, are a problem (33-36).
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