title: [Clinical characteristics and long-term follow-up analysis of three cases with newborn aristolochic acid nephropathy].
abstract: OBJECTIVE
  To summarize the clinical characteristics and prognosis of newborn aristolochic acid nephropathy induced by akebia.
  
  
  METHODS
  Retrospective analysis of clinical manifestations, therapy and prognosis was made upon data of 3 newborn infants with renal function lesion induced by akebia.
  
  
  RESULTS
  Three infants who were fed with Chinese herbal medicines containing akebia trifoliate suffered from acute renal failure, renal glomerular and tubular injury, with symptoms of vomiting, diarrhea, and oliguria. Laboratory tests manifested hyperpotassemia, hyponatremia, elevation of serum creatinine and urea nitrogen, and metabolic acidosis. Renal glomerular lesion was mild, presented with proteinuria and increased serum β(2) microglobin. Renal dysfunction was manifested with alkaline urine, glucosuria, positiveness of urine glucose, ketone and aminoaciduria, and increased urine β(2) microglobin excretion. After symptomatic treatment for 3 to 4 weeks, the renal function of these infants recovered. Proteinuria, aminoaciduria and glucosuria turned negative within 5 to 8 months, 3 months to 1 year, and 9 months to 3 years, respectively. Urine pH decreased to 7.0 after 5.0 - 5.5 years. All cases took citric acid mixtures for 5.5 to 6 years. A 12-years follow-up demonstrated that serum creatinine of 3 cases were within normal range during the first 11 years of life, however recent follow-up showed increased serum creatinine of case 1 and case 2, except for serum creatinine of case 3 remained normal. The estimated glomerular filtration rate (eGFR) of all the 3 cases decreased. Among which, eGFR of case 1 and case 2 were lower than 90 [ml/(min·1.73 m(2))], and decreased 1.1 [ml/(min·1.73 m(2))] and 0.6 [ml/(min·1.73 m(2))] per year during recent six years, respectively. No obvious decrease of eGFR was observed in case 3. Blood gas analysis and urine routine were normal, yet blood and urine β(2) microglobin excretion were still high. Urinary N-acetyl-β-D-glucosaminidase increased again after having returned to normal.
  
  
  CONCLUSIONS
  Newborn aristolochic acid nephropathy induced by akebia might induce acute renal failure and renal tubules injury. Renal function could recover after symptomatic treatment in short-term. Nevertheless, glomerular filtration rate presents a slow descending tendency and renal tubules lesion lasted for many years, which requires a long-term follow-up.
authors.affiliation: Department of Pediatrics, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zheng-hong
authors.initials: ZH
authors.lastname: Li
authors.forename: Min
authors.initials: M
authors.lastname: Wei
authors.forename: Guo-fang
authors.initials: GF
authors.lastname: Ding
authors.forename: Dan-hua
authors.initials: DH
authors.lastname: Wang
mesh_terms: D034341:Aristolochic Acids / Q000009:adverse effects*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000139:chemically induced*; D007683:Kidney Tubular Necrosis, Acute / Q000139:chemically induced; D019684:Magnoliopsida / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies
chemical_list: D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal; C000228:aristolochic acid I