title: [Aristolochic acid nephropathy ("Chinese herb nephropathy")].
abstract: Aristolochic acid nephropathy is a renal disease of toxic origin characterized by a progressive interstitial fibrosis and frequently associated with urinary tract cancer. It was initially reported in Belgium after the intake of slimming pills containing root extracts of a Chinese herb, Aristolochia fangchi. In the following decades, numerous cases have been reported worldwide, particularly in Asian countries. Several experimental models of aristolochic acid nephropathy (AAN) have been designed. They confirm the causal link between AA exposure and the onset of acute and chronic renal toxicity, as well as urinary tract cancer. These experimental models offer the opportunity to study the mechanisms of renal interstitial fibrosis and carcinogenesis. In terms of public health, the history of this nephropathy demonstrates that it is mandatory to submit all "natural medicinal products" to the same controls of efficacy, toxicity and conformity applied to the classical drugs derived from the pharmaceutical producers. Any unusual observation of renal failure and/or cancer of the urinary tract should lead to a questioning about any prior exposure to AA. The confirmation of the ingestion of AA containing compounds by phytochemical analysis is not always feasible. However, the renal biopsy remains a crucial diagnostic point through the demonstration of a hypocellular interstitial fibrosis with a decreasing corticomedullary gradient, mostly in advanced cases of kidney disease. Moreover, the detection of AA-related DNA adducts within a renal or urothelial tissue sample could confirm the prior AA exposure. The persistence of these specific DNA adducts in renal tissue is very long (up to 20 years). Finally, considering the highly carcinogenic properties of AA, a systematic endo-urological screening is absolutely necessary.
authors.affiliation: Service de néphrologie, dialyse et transplantation rénale, hôpital Érasme, université Libre de Bruxelles, route de Lennik, 808, 1070 Bruxelles, Belgique; Laboratoire de néphrologie expérimentale, faculté de médecine, campus Érasme, CP-626, route de Lennik, 808, 1070 Bruxelles, Belgique. Electronic address: joelle.nortier@erasme.ulb.ac.be.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Nortier
authors.affiliation: Service de néphrologie, dialyse et transplantation rénale, hôpital Érasme, université Libre de Bruxelles, route de Lennik, 808, 1070 Bruxelles, Belgique; Laboratoire de néphrologie expérimentale, faculté de médecine, campus Érasme, CP-626, route de Lennik, 808, 1070 Bruxelles, Belgique.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Pozdzik
authors.affiliation: Service d'urologie, hôpital Érasme, université Libre de Bruxelles, route de Lennik, 808, 1070 Bruxelles, Belgique.
authors.forename: Thierry
authors.initials: T
authors.lastname: Roumeguere
authors.affiliation: Service de néphrologie, dialyse et transplantation rénale, hôpital Érasme, université Libre de Bruxelles, route de Lennik, 808, 1070 Bruxelles, Belgique; Laboratoire de néphrologie expérimentale, faculté de médecine, campus Érasme, CP-626, route de Lennik, 808, 1070 Bruxelles, Belgique.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanherweghem
mesh_terms: D034341:Aristolochic Acids / Q000009:adverse effects*; D018736:DNA Adducts; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000473:pathology; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D014571:Urologic Neoplasms / Q000139:chemically induced*
chemical_list: D034341:Aristolochic Acids; D018736:DNA Adducts; D004365:Drugs, Chinese Herbal
keywords: Acides aristolochiques; Adduits d’ADN; Aristolochic acids; Carcinome transitionnel; DNA adducts; Fibrose interstitielle; Interstitial fibrosis; Néphropathie toxique; Phytotherapy; Phytothérapies; Toxic nephropathy; Transitional carcinoma