Effect of Henna-Induced Pigment Nephropathy on Kidney Outcomes: A Systematic Review and Meta-Analysis
Introduction: Henna is extracted from a plant with scientific name of lawsonia intermis (Lawsonia alba) that is used for hair dye and fortified henna which is used for tattooing. The aim of this research was effect size assessment of henna on kidney outcomes.
Methods: In this systematic review and meta-analysis, thirty patients with henna and kidney impairment were considered. Clinical presentation, biochemical data, imaging, therapeutic modalities and follow up of data of patients were investigated. Prevalence rate of categorical variables was assessed with frequency and percentage and continuous variables with mean and median. Effect size of henna-induced pigment nephropathy was assessed using mean difference by Cohenʼs d test.
Results: In this study, nine out of thirty patients had history of topical/inhalational and twenty-one (70%) consumed swallowed mixed henna with paraphenylenediamine via various hair dyes or traditional alternative medicine. Para-phenylenediamine was detected in urine of 10% of patients using thin layer chromatography (TLG) and thin layer chromatography-gas chromatography/mass spectrometry (TLC-GC/MS) method. Three patients developed acute kidney injury (AKI) and one patient acute kidney disease (AKD) during follow up. Effect size of elevated serum creatinine based on the last serum creatinine measurement or the last serum creatinine measurement on dialysis modalities using standardized mean difference by Cohen̕s-d law was 1.637 (large effect). The mean average of pre-hemodialysis serum creatinine level and post-hemodialysis serum creatinine level was 7.04±4.90 and 4.59±3.06 mg/dl, respectively. Comparison between two variables using paired t test was assessed with p-value of 0.37. Nine out of thirty patients died in the present research.
Conclusion: Henna-induced pigment nephropathy is a disease due to hair-dye consumption. Hair dye related AKI and AKD was seen in 10% and 3.3% of patients, respectively. Effect of mixed henna on kidney outcome was assessed large in this research. Furthermore, the current research revealed high mortality proportion in henna users. Attaining to zero death in mixed henna-induced pigment nephropathy is a target.
Keywords: Henna, Dye-Related Acute Kidney Injury, Para-Phenylenediamine, Kaplan-Miere Analysis