title: Urothelial lesions in Chinese-herb nephropathy.
abstract: Rapidly progressive renal fibrosis after a slimming regimen including Chinese herbs containing aristolochic acid (AA) has been identified as Chinese-herb nephropathy (CHN). We reported urothelial atypia in three patients with CHN, with the subsequent development in one patient of overt transitional cell carcinoma (TCC). Therefore, it was decided to remove the native kidneys, as well as the ureters, in all patients with CHN. Nineteen kidneys and ureters removed during and/or after renal transplantation from 10 patients were studied to assess critically urothelial lesions and to characterize the cellular expression of p53, a tumor-suppressor gene overexpressed in several types of malignancies. Multifocal high-grade flat TCC in situ (carcinoma in situ; CiS) was observed, mainly in the upper urinary tract, in four patients, a prevalence of 40%. In one of those patients, a superficially invasive flat TCC of the right upper ureter, as well as two additional foci of noninvasive papillary TCC, were found in the right pelvis and left lower ureter, respectively. This patient also presented recurrent noninvasive papillary TCC of the bladder. Furthermore, in all cases, multifocal, overall moderate atypia was found in the medullary collecting ducts, pelvis, and ureter. All CiS and papillary TCC, as well as urothelial atypia, overexpressed p53. These results show that the intake of Chinese herbs containing AA has a dramatic carcinogenic effect. Carcinogenesis is associated with the overexpression of p53, which suggests a role for a p53 gene mutation. The relationship of this mutation with the reported presence of AA DNA adducts in the kidney remains to be explored.
authors.affiliation: Departments of Pathology, Nephrology, Renal and Pancreatic Transplantation, and Urology, Université Catholique de Louvain, Brussels, Belgium. cosyns@anps.ucl.ac.be
authors.forename: J P
authors.initials: JP
authors.lastname: Cosyns
authors.forename: M
authors.initials: M
authors.lastname: Jadoul
authors.forename: J P
authors.initials: JP
authors.lastname: Squifflet
authors.forename: F X
authors.initials: FX
authors.lastname: Wese
authors.forename: C
authors.initials: C
authors.lastname: van Ypersele de Strihou
mesh_terms: D000328:Adult; D034341:Aristolochic Acids; D002273:Carcinogens; D002278:Carcinoma in Situ / Q000139:chemically induced*; D002295:Carcinoma, Transitional Cell / Q000139:chemically induced*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000235:genetics / Q000473:pathology; D007680:Kidney Neoplasms / Q000139:chemically induced*; D008875:Middle Aged; D010616:Phenanthrenes / Q000009:adverse effects*; D016159:Tumor Suppressor Protein p53 / Q000032:analysis; D014513:Ureter / Q000473:pathology; D014516:Ureteral Neoplasms / Q000139:chemically induced
chemical_list: D034341:Aristolochic Acids; D002273:Carcinogens; D004365:Drugs, Chinese Herbal; D010616:Phenanthrenes; D016159:Tumor Suppressor Protein p53; C000228:aristolochic acid I