title: Detection of Herba Aristolochia Mollissemae in a patient with unexplained nephropathy.
abstract: The authors report a case of unexplained nephropathy 2 months after ingestion of Herba Aristolochia Mollissemae in a patient with long-standing Crohn's disease and recently diagnosed carcinoma of the colon. It presented as a relentlessly progressing hypocellular interstitial nephritis 5 months after cessation of an earlier course of mesalazine. The patient finally had end-stage renal failure 12 months after taking herbs and required hemodialysis. Aristolochic acid (AA) was detected in the herbal sample of Herba Aristolochia Mollissemae by high-performance liquid chromatography-diode array detection and electrospray ionization-tandem mass spectrometry. Specific AA-DNA adducts were detected in the renal biopsy by 32 P-postlabelling analysis. Transitional cell carcinoma was diagnosed 5 months after herb ingestion. It was found that the originally prescribed nonnephrotoxic herb had been substituted by AA-containing Herba Aristolochia Mollissemae at the wholesaler level. Although AA-associated nephropathy could not be proved conclusively, the current case contributed to the withdrawal of the AA-related herbs by the local health authority in Hong Kong. Physicians should be on the alert for herbal nephrotoxicity by possible replacement of nontoxic herbs by nephrotoxic herbs.
authors.affiliation: Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, China. stanleylo@alumni.cuhk.net <stanleylo@alumni.cuhk.net>
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Lo
authors.forename: Kin-shing
authors.initials: KS
authors.lastname: Wong
authors.forename: Volker M
authors.initials: VM
authors.lastname: Arlt
authors.forename: David H
authors.initials: DH
authors.lastname: Phillips
authors.forename: Chi-kong
authors.initials: CK
authors.lastname: Lai
authors.forename: Wing-Tat
authors.initials: WT
authors.lastname: Poon
authors.forename: Ching-kit
authors.initials: CK
authors.lastname: Chan
authors.forename: Ka-leung
authors.initials: KL
authors.lastname: Mo
authors.forename: Kwok-wah
authors.initials: KW
authors.lastname: Chan
authors.forename: Albert
authors.initials: A
authors.lastname: Chan
mesh_terms: D029065:Aristolochiaceae / Q000378:metabolism* / Q000506:poisoning*; D034341:Aristolochic Acids / Q000032:analysis / Q000506:poisoning; D006801:Humans; D007668:Kidney / Q000737:chemistry / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000139:chemically induced*; D028321:Plant Preparations / Q000378:metabolism / Q000506:poisoning
chemical_list: D034341:Aristolochic Acids; D028321:Plant Preparations