title: Aristolochic acid nephropathy due to herbal drug intake manifested differently as Fanconi's syndrome and end-stage renal failure--a 7-year follow-up.
abstract: Aristolochic acid (AA) may reduce glomerular or proximal tubular function, or both. We report a married couple taking AA-containing herbal drugs. The man developed Fanconi's syndrome (FS) whereas his wife reached end-stage renal failure (ESRF). He was a 36-year-old alcoholic cirrhotic patient who had taken the Chinese herbal drugs for 6 years, presenting with muscle weakness and laboratory findings of FS; the renal pathological findings were compatible with the diagnosis of aristolochic acid nephropathy (AAN). His 38-year-old wife, who took a lower cumulative amount of the same herbal drug for a shorter duration, developed advanced renal failure and severe anemia with pathological findings of extensive tubular atrophy, interstitial fibrosis but spared glomeruli. AA-I was detected in one of the herbal drugs. The wife has been on hemodialysis for 7 years, but the husband is still at the stage of slowly progressive chronic renal failure and persistent FS. None of their 5 children ever took the herbal drug, and none had renal problems during follow-up. It is important to trace the history of herbal drug intake in all the family members because of the possibility of sharing of drugs within a family. In addition to the effect of cumulative doses of AAs and the potentially higher susceptibility of females to AAN, the roles of liver cirrhosis and related vasodilators in the protection of the renal interstitium from fibrosis are questions that warrant further study.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: P-I
authors.initials: PI
authors.lastname: Kong
authors.forename: Y-W
authors.initials: YW
authors.lastname: Chiu
authors.forename: M-C
authors.initials: MC
authors.lastname: Kuo
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: J-M
authors.initials: JM
authors.lastname: Chang
authors.forename: J-C
authors.initials: JC
authors.lastname: Tsai
authors.forename: S-J
authors.initials: SJ
authors.lastname: Hwang
authors.forename: H-C
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D034341:Aristolochic Acids / Q000009:adverse effects* / Q000032:analysis; D002851:Chromatography, High Pressure Liquid; D003937:Diagnosis, Differential; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005198:Fanconi Syndrome / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis*; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology; D008297:Male; D009153:Mutagens / Q000009:adverse effects / Q000032:analysis; D028321:Plant Preparations / Q000009:adverse effects* / Q000737:chemistry; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis; D013997:Time Factors
chemical_list: D034341:Aristolochic Acids; D009153:Mutagens; D028321:Plant Preparations; C000228:aristolochic acid I