Adverse reactions to Rubia peregrina L.: Two case reports from Morocco

Background Medicinal plants (MPs) can cause adverse reactions (ARs) particularly affecting major detoxification organs, the kidneys. This study aims to document two cases of nephrotoxicity associated with Rubia peregrina L. ( R. peregrina) , a plant recognized for its medicinal properties but also potential toxicity. Methods An ethnobotanical study was conducted at Ibn Sina Hospital in Rabat, Morocco, involving two female patients aged 59 and 75, both presenting with anemia and no prior history of renal disease. Data were collected using a semi-structured questionnaire, and plant samples were identified. The study received ethical approval (n°05/23). Case presentation Case 1: A 59-year-old woman developed chronic renal failure requiring hemodialysis after ingesting madder root powder. Causality assessment indicated a possible link to the use of the plant. Case 2: A 75-year-old woman experienced renal failure following the consumption of a madder root decoction. Causality assessment also suggested a possible association. Neither patient had reported ARs prior to hospitalization. Conclusions This study is the first to document ARs linked to R. peregrina in humans, highlighting the avant nephrotoxic risks associated with its anthraquinone compounds. Despite its traditional use, the potential for serious renal damage calls for caution, further research, and regulatory measures for MPs.