title: Risk assessment of upper tract urothelial carcinoma related to aristolochic acid.
abstract: BACKGROUND
  Aristolochic acid is a toxin found in plants of the genus Aristolochia, to which humans can be exposed either through certain Chinese herbal medicines or through inadvertent commingling with food crops. Our objective was to estimate cumulative exposures of aristolochic acid associated with increased risk of end-stage renal disease (ESRD), and to conduct a systematic review and meta-analysis on aristolochic acid-induced upper tract urothelial carcinoma (UUC).
  
  
  METHODS
  Using epidemiologic studies on aristolochic acid-related disease from multiple different regions of the world, a systematic review was conducted in which relative risks (RR), HRs, and ORs were derived or extracted directly, and a meta-analysis was conducted. One study was used to estimate a benchmark dose lower confidence limit (BMDL) for aristolochic acid-related ESRD.
  
  
  RESULTS
  Mean values for risk ratios, ORs, RRs, or HRs, of UUC caused by aristolochic acid ranged from 1 to 49. A meta-analysis of these studies resulted in a pooled OR of 5.97 [95% confidence interval (CI), 2.78-12.84] for this aristolochic acid-related cancer. The obtained BMDL for aristolochic acid-related ESRD was 0.42 g cumulative aristolochic acid exposure.
  
  
  CONCLUSIONS
  Aristolochic acid exposure is significantly associated with an increased risk of UUC, and there is a dose-dependent relationship between cumulative aristolochic acid exposure and ESRD risk.
  
  
  CONCLUSIONS
  Individuals who use certain Chinese herbal medicines may significantly increase their risk of developing UUC and/or ESRD, as would individuals who are inadvertently exposed to aristolochic acid through commingling of Aristolochia plants with harvested food crops.
authors: Michigan State University, 469 Wilson Rd, East Lansing, MI 48824, USA. fwu@msu.edu
authors: Felicia
authors: F
authors: Wu
authors: Tianxiu
authors: T
authors: Wang
mesh_terms: D034341:Aristolochic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000453:epidemiology* / Q000235:genetics; D018570:Risk Assessment; D012307:Risk Factors; D014523:Urethral Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000235:genetics
chemical_list: D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal