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• W2033089404 abstract "Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies, was initially reported in a Belgian cohort of more than 100 patients after the intake of slimming pills containing a Chinese herb, Aristolochia fangchi. Although botanicals known or suspected to contain aristolochic acid (AA) were no longer permitted in many countries, several AAN cases were regularly observed all around the world. The incidence of AAN is probably much higher than initially thought, especially in Asia and the Balkans. In Asian countries, where traditional medicines are very popular, the complexity of the pharmacopoeia represents a high risk for AAN because of the frequent substitution of the botanical products by AA-containing herbs. In the Balkan regions, the exposure to AA found in flour obtained from wheat contaminated with seeds of Aristolochia clematitis could be responsible for the so-called Balkan-endemic nephropathy. Finally, despite the Food and Drug Administration's warnings concerning the safety of botanical remedies containing AA, these herbs are still sold via the Internet. Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies, was initially reported in a Belgian cohort of more than 100 patients after the intake of slimming pills containing a Chinese herb, Aristolochia fangchi. Although botanicals known or suspected to contain aristolochic acid (AA) were no longer permitted in many countries, several AAN cases were regularly observed all around the world. The incidence of AAN is probably much higher than initially thought, especially in Asia and the Balkans. In Asian countries, where traditional medicines are very popular, the complexity of the pharmacopoeia represents a high risk for AAN because of the frequent substitution of the botanical products by AA-containing herbs. In the Balkan regions, the exposure to AA found in flour obtained from wheat contaminated with seeds of Aristolochia clematitis could be responsible for the so-called Balkan-endemic nephropathy. Finally, despite the Food and Drug Administration's warnings concerning the safety of botanical remedies containing AA, these herbs are still sold via the Internet. Aristolochic acid nephropathy (AAN), a rapidly progressive interstitial nephritis leading to end-stage renal disease and urothelial malignancy, was originally reported in Belgium in a group of patients who had ingested slimming pills containing powdered root extracts of Chinese herbs (Figure 1a and b).1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar,2.Depierreux M. Van Damme B. Vanden Houte K. et al.Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs.Am J Kidney Dis. 1994; 24: 172-180Abstract Full Text PDF PubMed Scopus (226) Google Scholar,3.Vanhaelen M. Vanhaelen-Fastre R. But P. et al.Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343: 174Abstract PubMed Scopus (292) Google Scholar,4.Cosyns J.P. Jadoul M. Squifflet J.P. et al.Urothelial malignancy in nephropathy due to Chinese herbs.Lancet. 1994; 344: 188Abstract PubMed Scopus (81) Google Scholar This nephropathy, initially called Chinese-herb nephropathy (CHN), appeared to be the dramatic consequence of a substitution of Stephania tetrandra by Aristolochia fangchi rich in aristolochic acid (AA), because both herbs share the same common name in Pin Yin (Han Fang Ji and Guang Fang Ji), and one can be used instead of the other in traditional Chinese medicine irrespective of their botanical classification.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar,3.Vanhaelen M. Vanhaelen-Fastre R. But P. et al.Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343: 174Abstract PubMed Scopus (292) Google Scholar,5.Wu K.M. Farrelly J.G. Upton R. et al.Complexities of the herbal nomenclature system in traditional Chinese medicine (TCM): lessons learned from the misuse of Aristolochia-related species and the importance of the pharmaceutical name during botanical drug product development.Phytomedicine. 2007; 14: 273-279Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar After the publication of the index cases, new cases of AAN were regularly reported, not only in Belgium but also worldwide (Figure 1a).1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar,2.Depierreux M. Van Damme B. Vanden Houte K. et al.Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs.Am J Kidney Dis. 1994; 24: 172-180Abstract Full Text PDF PubMed Scopus (226) Google Scholar,3.Vanhaelen M. Vanhaelen-Fastre R. But P. et al.Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343: 174Abstract PubMed Scopus (292) Google Scholar,4.Cosyns J.P. Jadoul M. Squifflet J.P. et al.Urothelial malignancy in nephropathy due to Chinese herbs.Lancet. 1994; 344: 188Abstract PubMed Scopus (81) Google Scholar,6.Pourrat J. Montastruc J.L. Lacombe J.L. et al.Néphropathie associée à des herbes chinoises—2 cas.Presse Med. 1994; 23: 1669PubMed Google Scholar,7.Vanherweghem J.L. Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese herbs nephropathy).J Altern Complement Med. 1998; 4: 9-13Crossref PubMed Scopus (177) Google Scholar,8.Pena J.M. Borras M. Ramos J. et al.Rapidly progressive interstitial renal fibrosis due to a chronic intake of a herb (Aristolochia pistolochia) infusion.Nephrol Dial Transplant. 1996; 11: 1359-1360Crossref PubMed Scopus (64) Google Scholar,9.Stengel B. Jones E. Insuffisance rénale terminale associée à la consommation d’herbes chinoises en France.Nephrologie. 1998; 19: 15-20PubMed Google Scholar,10.Lord G.M. Tagore R. Cook T. et al.Nephropathy caused by Chinese herbs in the UK.Lancet. 1999; 354: 481-482Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar,11.Tanaka A. Nishida R. Yokoi H. et al.The characteristic pattern of aminoaciduria in patients with aristolochic acid-induced Fanconi syndrome: could iminoaciduria be the hallmark of this syndrome?.Clin Nephrol. 2000; 54: 198-202PubMed Google Scholar,12.Tanaka A. Nishida R. Maeda K. et al.Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy?.Clin Nephrol. 2000; 53: 301-306PubMed Google Scholar,13.Meyer M.M. Chen T.P. Bennett W.M. Chinese herb nephropathy.Proc (Bayl Univ Med Cent). 2000; 13: 334-337PubMed Google Scholar,14.Yang C.S. Lin C.H. Chang S.H. et al.Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs.Am J Kidney Dis. 2000; 35: 313-318Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar,15.Krumme B. Endmeir R. Vanhaelen M. et al.Reversible Fanconi syndrome after ingestion of a Chinese herbal ‘remedy’ containing aristolochic acid.Nephrol Dial Transplant. 2001; 16: 400-402Crossref PubMed Scopus (36) Google Scholar,16.Chang C.H. Wang Y.M. Yang A.H. et al.Rapidly progressive interstitial renal fibrosis associated with Chinese herbal medications.Am J Nephrol. 2001; 21: 441-448Crossref PubMed Scopus (76) Google Scholar,17.Cronin A.J. Maidment G. Cook T. et al.Aristolochic acid as a causative factor in a case of Chinese herbal nephropathy.Nephrol Dial Transplant. 2002; 17: 524-525Crossref PubMed Scopus (23) Google Scholar,18.Lee S. Lee T. Lee B. et al.Fanconi's syndrome and subsequent progressive renal failure caused by a Chinese herb containing aristolochic acid.Nephrology (Carlton). 2004; 9: 126-129Crossref PubMed Scopus (54) Google Scholar,19.Lo S.H. Mo K.L. Wong K.S. et al.Aristolochic acid nephropathy complicating a patient with focal segmental glomerulosclerosis.Nephrol Dial Transplant. 2004; 19: 1913-1915Crossref PubMed Scopus (28) Google Scholar,20.Laing C. Hamour S. Sheaff M. et al.Chinese herbal uropathy and nephropathy.Lancet. 2006; 368: 338Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar,21.Yang L. Li X. Wang H. Possible mechanisms explaining the tendency towards interstitial fibrosis in aristolochic acid-induced acute tubular necrosis.Nephrol Dial Transplant. 2007; 22: 445-456Crossref PubMed Scopus (85) Google Scholar,22.Poon W.T. Lai C.K. Chan A. Aristolochic acid nephropathy: the Hong Kong perspective.Hong Kong J Nephrol. 2007; 9: 7-14Abstract Full Text PDF Scopus (19) Google Scholar,23.Grollman A.P. Shibutani S. Moriya M. et al.Aristolochic acid and the etiology of endemic (Balkan) nephropathy.Proc Natl Acad Sci USA. 2007; 104: 12129-12134Crossref PubMed Scopus (440) Google Scholar Actually, the true incidence of AAN is largely unknown and probably underestimated, as numerous ingredients known or suspected to contain AA are used in traditional medicine in China, Japan, and India (Figure 1c).24.Zhu M. Phillipson J.D. Hong Kong samples of the traditional Chinese medicine ‘Fang ji’ contain aristolochic acid toxins.Int J Pharmacognosy. 1996; 34: 283-289Crossref Scopus (5) Google Scholar,25.Hashimoto K. Higuchi M. Makino B. et al.Quantitative analysis of aristolochic acids, toxic compounds, contained in some medicinal plants.J Ethnopharmacol. 1999; 64: 185-189Crossref PubMed Scopus (110) Google Scholar,26.Vanherweghem J.L. Aristolochia sp and chronic interstitial nephropathies in Indians.Lancet. 1997; 349: 1399Abstract Full Text Full Text PDF PubMed Scopus (26) Google ScholarFigure 1Aristolochic acid nephropathy: a worldwide problem. (a) Counting cases of CHN/AAN around the world reported in the literature.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar,2.Depierreux M. Van Damme B. Vanden Houte K. et al.Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs.Am J Kidney Dis. 1994; 24: 172-180Abstract Full Text PDF PubMed Scopus (226) Google Scholar,3.Vanhaelen M. Vanhaelen-Fastre R. But P. et al.Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343: 174Abstract PubMed Scopus (292) Google Scholar,4.Cosyns J.P. Jadoul M. Squifflet J.P. et al.Urothelial malignancy in nephropathy due to Chinese herbs.Lancet. 1994; 344: 188Abstract PubMed Scopus (81) Google Scholar,6.Pourrat J. Montastruc J.L. Lacombe J.L. et al.Néphropathie associée à des herbes chinoises—2 cas.Presse Med. 1994; 23: 1669PubMed Google Scholar,7.Vanherweghem J.L. Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese herbs nephropathy).J Altern Complement Med. 1998; 4: 9-13Crossref PubMed Scopus (177) Google Scholar,8.Pena J.M. Borras M. Ramos J. et al.Rapidly progressive interstitial renal fibrosis due to a chronic intake of a herb (Aristolochia pistolochia) infusion.Nephrol Dial Transplant. 1996; 11: 1359-1360Crossref PubMed Scopus (64) Google Scholar,9.Stengel B. Jones E. Insuffisance rénale terminale associée à la consommation d’herbes chinoises en France.Nephrologie. 1998; 19: 15-20PubMed Google Scholar,10.Lord G.M. Tagore R. Cook T. et al.Nephropathy caused by Chinese herbs in the UK.Lancet. 1999; 354: 481-482Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar,11.Tanaka A. Nishida R. Yokoi H. et al.The characteristic pattern of aminoaciduria in patients with aristolochic acid-induced Fanconi syndrome: could iminoaciduria be the hallmark of this syndrome?.Clin Nephrol. 2000; 54: 198-202PubMed Google Scholar,12.Tanaka A. Nishida R. Maeda K. et al.Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy?.Clin Nephrol. 2000; 53: 301-306PubMed Google Scholar,13.Meyer M.M. Chen T.P. Bennett W.M. Chinese herb nephropathy.Proc (Bayl Univ Med Cent). 2000; 13: 334-337PubMed Google Scholar,14.Yang C.S. Lin C.H. Chang S.H. et al.Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs.Am J Kidney Dis. 2000; 35: 313-318Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar,15.Krumme B. Endmeir R. Vanhaelen M. et al.Reversible Fanconi syndrome after ingestion of a Chinese herbal ‘remedy’ containing aristolochic acid.Nephrol Dial Transplant. 2001; 16: 400-402Crossref PubMed Scopus (36) Google Scholar,16.Chang C.H. Wang Y.M. Yang A.H. et al.Rapidly progressive interstitial renal fibrosis associated with Chinese herbal medications.Am J Nephrol. 2001; 21: 441-448Crossref PubMed Scopus (76) Google Scholar,17.Cronin A.J. Maidment G. Cook T. et al.Aristolochic acid as a causative factor in a case of Chinese herbal nephropathy.Nephrol Dial Transplant. 2002; 17: 524-525Crossref PubMed Scopus (23) Google Scholar,18.Lee S. Lee T. Lee B. et al.Fanconi's syndrome and subsequent progressive renal failure caused by a Chinese herb containing aristolochic acid.Nephrology (Carlton). 2004; 9: 126-129Crossref PubMed Scopus (54) Google Scholar,19.Lo S.H. Mo K.L. Wong K.S. et al.Aristolochic acid nephropathy complicating a patient with focal segmental glomerulosclerosis.Nephrol Dial Transplant. 2004; 19: 1913-1915Crossref PubMed Scopus (28) Google Scholar,20.Laing C. Hamour S. Sheaff M. et al.Chinese herbal uropathy and nephropathy.Lancet. 2006; 368: 338Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar,21.Yang L. Li X. Wang H. Possible mechanisms explaining the tendency towards interstitial fibrosis in aristolochic acid-induced acute tubular necrosis.Nephrol Dial Transplant. 2007; 22: 445-456Crossref PubMed Scopus (85) Google Scholar,22.Poon W.T. Lai C.K. Chan A. Aristolochic acid nephropathy: the Hong Kong perspective.Hong Kong J Nephrol. 2007; 9: 7-14Abstract Full Text PDF Scopus (19) Google Scholar,23.Grollman A.P. Shibutani S. Moriya M. et al.Aristolochic acid and the etiology of endemic (Balkan) nephropathy.Proc Natl Acad Sci USA. 2007; 104: 12129-12134Crossref PubMed Scopus (440) Google Scholar (b) CHNA/AAN is a rapidly progressive interstitial nephritis leading to end-stage renal disease and urothelial malignancy, which was originally reported in Belgium in the context of the intake of slimming pills containing powdered Chinese herbs (A. fangchi). (c) The true incidence of AAN is largely unknown and probably underestimated, as numerous ingredients known or suspected to contain AA are used in traditional medicines in India and Eastern Asia (see Tables 1, 2 and 3 for more details). (d) Finally, another reason to suspect a higher number of AAN cases is based on the hypothesis that the exposure to seeds of Aristolochia clematitis comingled with wheat grain during the annual harvest could be responsible for BEN.View Large Image Figure ViewerDownload (PPT) Another reason to suspect a higher number of AAN cases is based on the hypothesis that AA could be an environmental cause of Balkan-endemic nephropathy (BEN), which is a familial chronic tubulointerstitial disease characterized by an insidious onset, a slow progression to end-stage renal disease, and an increased frequency of urothelial cancer.23.Grollman A.P. Shibutani S. Moriya M. et al.Aristolochic acid and the etiology of endemic (Balkan) nephropathy.Proc Natl Acad Sci USA. 2007; 104: 12129-12134Crossref PubMed Scopus (440) Google Scholar This nephropathy is endemic in Serbia, Bosnia, Croatia, Bulgaria, and Romania (Figure 1d).27.Stefanovic V. Toncheva D. Atanasova S. et al.Etiology of Balkan endemic nephropathy and associated urothelial cancer.Am J Nephrol. 2006; 26: 1-11Crossref PubMed Scopus (98) Google Scholar Finally, despite the Food and Drug Administration's warnings regarding the safety of botanical remedies containing AA (known or suspected to contain AA), plants containing AA are still available via the Internet.28.Gold L.S. Slone T.H. Aristolochic acid, an herbal carcinogen, sold on the Web after FDA alert.N Engl J Med. 2003; 349: 1576-1577Crossref PubMed Scopus (95) Google Scholar In 1992, two young women with no previous history of renal disease were admitted in our Nephrology department in Brussels (Belgium) with severe interstitial nephritis that progressed over a couple of months to end-stage renal disease.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar One year before, these two patients had followed the same weight-loss program in the same medical clinic in Brussels. Interestingly, the composition of weight-reducing pills was modified in June 1990 by introducing root extracts from two Chinese herbs, labeled as S. tetrandra and Magnolia officinalis.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar An epidemiological survey of the Nephrology centers of Brussels revealed an unusual, increased incidence of patients with ‘interstitial nephritis of unknown origin’ admitted for dialysis in 1991 and 1992.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar This survey identified seven other women who had followed the same slimming regimen containing the Chinese herbs.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar Confronted to this rapidly progressive nephropathy probably related to the ingestion of these two Chinese herbs, the Belgian authorities decided to ban S. tetrandra and M. officinalis from the Belgian market at the end of 1992. Despite this safety measure, more than 100 cases of CHN were reported in Belgium in 1998, 70% of them being in end-stage renal disease.7.Vanherweghem J.L. Misuse of herbal remedies: the case of an outbreak of terminal renal failure in Belgium (Chinese herbs nephropathy).J Altern Complement Med. 1998; 4: 9-13Crossref PubMed Scopus (177) Google Scholar The time correlation between the introduction of the Chinese herbs in weight-loss regimens and the appearance of this rapidly progressive interstitial renal fibrosis focused the search of the culprit on the Chinese herbs.1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar Very soon, the inadvertent replacement of Stephania by Aristolochia was suspected. First, S. tetrandra (Pin Yin name: Han Fang Ji) and A. fangchi (Pin Yin name: Guang Fang Ji) belong to the same therapeutic ‘Fang Ji’ family in traditional Chinese medicine, and the herbal ingredients are generally traded using their common Pin Yin name. Second, the pathological aspect of CHN is very similar to that of BEN, whose etiology is still controversial, but some suggested that AAs containing A. clematitis are the main culprit (see section below).1.Vanherweghem J.L. Depierreux M. Tielemans C. et al.Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Abstract PubMed Scopus (897) Google Scholar,2.Depierreux M. Van Damme B. Vanden Houte K. et al.Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs.Am J Kidney Dis. 1994; 24: 172-180Abstract Full Text PDF PubMed Scopus (226) Google Scholar,29.Cosyns J.P. Jadoul M. Squifflet J.P. et al.Chinese herbs nephropathy: a clue to Balkan endemic nephropathy?.Kidney Int. 1994; 45: 1680-1688Abstract Full Text PDF PubMed Scopus (242) Google Scholar,30.Stefanovic V. Polenakovic M.H. Balkan nephropathy. Kidney disease beyond the Balkans?.Am J Nephrol. 1991; 11: 1-11Crossref PubMed Scopus (55) Google Scholar The hypothesis of substitution was strengthened by the phytochemical analyses of the S. tetrandra batches revealing that most of them did not contain tetrandrine but AAs (0.65±0.56 mg g−1 of powder), the main compounds of the Aristolochia sp.3.Vanhaelen M. Vanhaelen-Fastre R. But P. et al.Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343: 174Abstract PubMed Scopus (292) Google Scholar A survey including 71 CHN/AAN patients followed in our department demonstrated in a multiple regression analysis that the cumulative dose of the so-called Stephania (in fact, Aristolochia) was the only significant factor predicting the slope of the inverse of plasma creatinine levels.31.Muniz Martinez M.C. Nortier J. Vereerstraeten P. et al.Progression rate of Chinese herb nephropathy: impact of Aristolochia fangchi ingested dose.Nephrol Dial Transplant. 2002; 17: 408-412Crossref PubMed Scopus (109) Google Scholar The causal role of AA was definitively confirmed by the detection of AA DNA adducts in kidney removed from CHN/AAN patients showing evidence of a previous exposure to AA.32.Schmeiser H.H. Bieler C.A. Wiessler M. et al.Detection of DNA adducts formed by aristolochic acid in renal tissue from patients with Chinese herbs nephropathy.Cancer Res. 1996; 56: 2025-2028PubMed Google Scholar,33.Nortier J.L. Muniz Martinez M.C. Schmeiser H.H. et al.Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi).N Engl J Med. 2000; 342: 1686-1692Crossref PubMed Scopus (868) Google Scholar In addition, the main histological and functional features of CHN/AAN were successfully reproduced by administrating AA to New Zealand white rabbits or male Wistar rats.34.Cosyns J.P. Dehoux J.P. Guiot Y. et al.Chronic aristolochic acid toxicity in rabbits: a model of Chinese herbs nephropathy?.Kidney Int. 2001; 59: 2164-2173Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,35.Debelle F.D. Nortier J.L. de Prez E.G. et al.Aristolochic acids induce chronic renal failure with interstitial fibrosis in salt-depleted rats.J Am Soc Nephrol. 2002; 13: 431-436PubMed Google Scholar Consequently, the term Chinese-herb nephropathy has been progressively abandoned and replaced by aristolochic acid nephropathy. After the first report of cases in Belgium, other similar cases were sporadically observed in France, Spain, Germany, United Kingdom, and the United States, in the context of herbal remedies for slimming purposes but also for all kinds of indications such as eczema, hepatitis B, ‘liver enhancement’, arthritis, rheumatism, and pain relief.6.Pourrat J. Montastruc J.L. Lacombe J.L. et al.Néphropathie associée à des herbes chinoises—2 cas.Presse Med. 1994; 23: 1669PubMed Google Scholar,8.Pena J.M. Borras M. Ramos J. et al.Rapidly progressive interstitial renal fibrosis due to a chronic intake of a herb (Aristolochia pistolochia) infusion.Nephrol Dial Transplant. 1996; 11: 1359-1360Crossref PubMed Scopus (64) Google Scholar,9.Stengel B. Jones E. Insuffisance rénale terminale associée à la consommation d’herbes chinoises en France.Nephrologie. 1998; 19: 15-20PubMed Google Scholar,10.Lord G.M. Tagore R. Cook T. et al.Nephropathy caused by Chinese herbs in the UK.Lancet. 1999; 354: 481-482Abstract Full Text Full Text PDF PubMed Scopus (243) Google Scholar,13.Meyer M.M. Chen T.P. Bennett W.M. Chinese herb nephropathy.Proc (Bayl Univ Med Cent). 2000; 13: 334-337PubMed Google Scholar,15.Krumme B. Endmeir R. Vanhaelen M. et al.Reversible Fanconi syndrome after ingestion of a Chinese herbal ‘remedy’ containing aristolochic acid.Nephrol Dial Transplant. 2001; 16: 400-402Crossref PubMed Scopus (36) Google Scholar,17.Cronin A.J. Maidment G. Cook T. et al.Aristolochic acid as a causative factor in a case of Chinese herbal nephropathy.Nephrol Dial Transplant. 2002; 17: 524-525Crossref PubMed Scopus (23) Google Scholar,20.Laing C. Hamour S. Sheaff M. et al.Chinese herbal uropathy and nephropathy.Lancet. 2006; 368: 338Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar As expected, numerous cases were also reported in Asian countries where the complexities of the traditional pharmacopoeia represent a high risk for AA exposure.12.Tanaka A. Nishida R. Maeda K. et al.Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy?.Clin Nephrol. 2000; 53: 301-306PubMed Google Scholar,14.Yang C.S. Lin C.H. Chang S.H. et al.Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs.Am J Kidney Dis. 2000; 35: 313-318Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar,16.Chang C.H. Wang Y.M. Yang A.H. et al.Rapidly progressive interstitial renal fibrosis associated with Chinese herbal medications.Am J Nephrol. 2001; 21: 441-448Crossref PubMed Scopus (76) Google Scholar,19.Lo S.H. Mo K.L. Wong K.S. et al.Aristolochic acid nephropathy complicating a patient with focal segmental glomerulosclerosis.Nephrol Dial Transplant. 2004; 19: 1913-1915Crossref PubMed Scopus (28) Google Scholar,21.Yang L. Li X. Wang H. Possible mechanisms explaining the tendency towards interstitial fibrosis in aristolochic acid-induced acute tubular necrosis.Nephrol Dial Transplant. 2007; 22: 445-456Crossref PubMed Scopus (85) Google Scholar,22.Poon W.T. Lai C.K. Chan A. Aristolochic acid nephropathy: the Hong Kong perspective.Hong Kong J Nephrol. 2007; 9: 7-14Abstract Full Text PDF Scopus (19) Google Scholar,36.Lo S.H. Wong K.S. Arlt V.M. et al.Detection of Herba Aristolochia mollissemae in a patient with unexplained nephropathy.Am J Kidney Dis. 2005; 45: 407-410Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar,37.Tanaka A. Nishida R. Yoshida T. et al.Outbreak of Chinese herb nephropathy in Japan: are there any differences from Belgium?.Intern Med. 2001; 40: 296-300Crossref PubMed Scopus (40) Google Scholar,38.Tsai C.S. Chen Y.C. Chen H.H. et al.An unusual cause of hypokalemic paralysis: aristolochic acid nephropathy with Fanconi syndrome.Am J Med Sci. 2005; 330: 153-155Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar,39.Yang S.S. Chu P. Lin Y.F. et al.Aristolochic acid-induced Fanconi's syndrome and nephropathy presenting as hypokalemic paralysis.Am J Kidney Dis. 2002; 39: E14Abstract Full Text Full Text PDF PubMed Google Scholar,40.Arlt V.M. Stiborova M. Schmeiser H.H. Aristolochic acid as a probable human cancer hazard in herbal remedies: a review.Mutagenesis. 2002; 17: 265-277Crossref PubMed Scopus (392) Google Scholar Clinically, the initial presentation of CHN/AAN was usually silent and the renal failure was discovered by routine blood testing.41.Vanherweghem J.L. Debelle F.D. Muniz-Martinez M.C. et al.Aristolochic acid nephropathy after Chinese herbal remedies.in: De Broe M.E. Porter G.A. Bennett W.M. Verpooten G.A. Clinical Nephrotoxins. 2nd edn. Kluwer Academic Publishers, Dordrecht2003: 579-586Crossref Google Scholar However, few cases presenting with a Fanconi syndrome or an acute renal failure due to tubular necrosis were reported in the literature.11.Tanaka A. Nishida R. Yokoi H. et al.The characteristic pattern of aminoaciduria in patients with aristolochic acid-induced Fanconi syndrome: could iminoaciduria be the hallmark of this syndrome?.Clin Nephrol. 2000; 54: 198-202PubMed Google Scholar,12.Tanaka A. Nishida R. Maeda K. et al.Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy?.Clin Nephrol. 2000; 53: 301-306PubMed Google Scholar,15.Krumme B. Endmeir R. Vanhaelen M. et al.Reversible Fanconi syndrome after ingestion of a Chinese herbal ‘remedy’ containing aristolochic acid.Nephrol Dial Transplant. 2001; 16: 400-402Crossref PubMed Scopus (36) Google Scholar,19.Lo S.H. Mo K.L. Wong K.S. et al.Aristolochic acid nephropathy complicating a patient with focal segmental glomerulosclerosis.Nephrol Dial Transplant. 2004; 19: 1913-1915Crossref PubMed Scopus (28) Google Scholar,21.Yang L. Li X. Wang H. Possible mechanisms explaining the tendency towards interstitial fibrosis in aristolochic acid-induced acute tubular necrosis.Nephrol Dial Transplant. 2007; 22: 445-456Crossref PubMed Scopus (85) Google Scholar Anemia was present and was often more severe than might have been anticipated from the degree of renal failure.42.van Ypersele de Strihou C. Vanherweghem J.L. The tragic paradigm of Chinese herbs nephropathy.Nephrol Dial Transplant. 1995; 10: 157-160PubMed Google Scholar In most of the cases, urinary sediment was unremarkable and dipstick analysis for albuminuria was negative.43.Reginster F. Jadoul M. van Ypersele de Strihou C. Chinese herbs nephropathy presentation, natural history and fate after transplantation.Nephrol Dial Transplant. 1997; 12: 81-86Crossref PubMed Scopus (79) Google Scholar How" @default.
• W2033089404 created "2016-06-24" @default.
• W2033089404 creator A5010579196 @default.
• W2033089404 creator A5047480887 @default.
• W2033089404 creator A5071554067 @default.
• W2033089404 date "2008-07-01" @default.
• W2033089404 modified "2023-10-18" @default.
• W2033089404 title "Aristolochic acid nephropathy: A worldwide problem" @default.
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• W2033089404 doi "https://doi.org/10.1038/ki.2008.129" @default.
• W2033089404 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/18418355" @default.

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