Old Wang, 62 years old, came to the hospital six months ago due to swelling of lower limbs and increased foam in urine, and was found to have urine protein 3+ and blood creatinine of 194umol/L. Ultrasound examination revealed that both kidneys were small with enhanced cortical echogenicity, and he was diagnosed with chronic renal insufficiency. The doctor told him that the treatment of chronic renal insufficiency can only slow down the rate of renal decompensation, and suggested him to strictly control blood pressure, low protein and high quality protein diet, and give other kidney-protective drugs to protect the residual renal function and prevent the progression to uremia. Last week, a pale Wang came back to the clinic with the help of his family, showing obvious swelling, low urine output, accompanied by nausea, vomiting, chest tightness and shortness of breath, and emergency blood biochemistry suggesting a blood creatinine of 1210umol/L, a hematocrit of 6g/dl, and severe hyperkalemia of 7.3mmol/L. The doctor said that Wang had progressed to end-stage uremia and was given emergency hemodialysis due to obvious hyperkalemia. He was given emergency hemodialysis. In just six months, Wang had progressed from the early stage of chronic renal failure to the end stage, the speed of disease development was much faster than expected, the doctor was baffled, and after careful questioning of Wang’s family, he understood. It turns out that six months ago in the hospital, the doctor said that there is no special drug to bring down the blood creatinine, the disease may slowly progress, and finally may develop into uremic syndrome. Hearing that it may become uremic syndrome, Lao Wang was scared to death and went home to ask around where there are prescriptions to treat renal insufficiency, and later prescribed a Chinese herbal remedy from a charlatan doctor. There was no obvious discomfort, but after taking the prescription for several months, the amount of urine gradually decreased, and there was significant weakness, loss of appetite, etc. The kidneys are an important excretory organ of the human body and can excrete a large number of metabolites from the body. The kidney is particularly rich in blood flow, accounting for 20%-25% of cardiac output, thus a large amount of drugs can enter the kidney after entering the body; when excreting metabolites, the kidney will concentrate the substances in the blood stream, resulting in a high concentration of excreted substances acting on the surface of the renal tubules, such as water-soluble drugs in the urine can reach 100 times the concentration of blood drugs, in addition, the proximal tubules have secretion and reabsorption effects on a variety of drugs, which also increases the concentration of drugs. In addition, the proximal tubule has the effect of secretion and reabsorption of many drugs, which also increases the chance of drug action with renal tubular epithelial cells. Due to the anatomical and physiological characteristics of the kidney, kidney function can be easily damaged if drugs are used carelessly, when the type, dose and time of use are inappropriate. From the traditional Chinese medicine prescription provided by Lao Wang’s family, the hospital pharmacist found that it contained mucuna pruriens. Although the Chinese medicine Moutong has diuretic and laxative effects, it has clear nephrotoxicity to the kidneys because it contains aristolochic acid, inducing aristolochic acid nephropathy, which manifests as acute renal failure in severe cases. It is particularly dangerous for patients with pre-existing kidney disease and can lead to rapid deterioration of chronic kidney disease. Chinese medicine is a Chinese national treasure, but, needless to say, some of its ingredients also have obvious liver and kidney toxicity, therefore, if you want to take Chinese medicine, you must go to a regular hospital and use it under the guidance of a Chinese medicine practitioner. In addition to the so-called traditional Chinese medicine prescriptions, some western medicines also have obvious nephrotoxicity, such as certain painkillers, aminoglycoside antibiotics, anti-tumor drugs, contrast agents used in radiological examinations and interventional procedures, etc., which may cause serious damage to the kidneys. Therefore, patients with kidney disease must be careful with drugs, to understand the possible nephrotoxicity of drugs, do not add or subtract drugs on their own, should be used under the guidance of a doctor to prevent drug damage to the kidneys.