광방기에 의해 발생한 Chinese Herb Nephropathy 1예
A case of chinese herb nephropathy induced by aristolochia fangchi
0
조회
0
다운로드
2
인용
0
참고문헌
초록
본 증례의 환자는 근위부 신세뇨관 산증, 진행성 만성 신부전증, 세뇨관 위축 및 간질 섬유화 등 CHN에 잘 맞는 임상 증상 및 조직 소견을 보였고, 복용하던 한약재에서 AA가 검출되어 AA에 의한 CHN 또는 AAN으로 진단할 수 있었다. 이러한 환자의 신조직에서 AA-DNA adduct를 추가로 검출할 수 있다면 진단의 정확성을 더욱 높일 수 있을 것으로 보인다.
Abstract
Chinese herb nephropathy (CHN) is characterized by progressive tubulointerstitial nephritis and development of renal failure in a couple of years after diagnosis. Aristolochic acid (AA) is believed to be associated with the development of CHN. The authors report a case of CHN in which AA in the herb regimen was identified by high-performance liquid chromatography (HPLC). A 32-year-old female presented with nausea, vomiting and generalized weakness. She had been taking Chinese herbs for symptomatic care. Clinical and laboratory examinations revealed Fanconi syndrome, renal failure, and severe anemia. Renal biopsy showed severe tubulointerstitial nephritis with moderate tubular atrophy and interstitial fibrosis. She developed end-stage renal failure 4 months after diagnosis. The herb she had been taking was Aristolochia fangchi. HPLC technique was used to identify AA and to measure its concentration in the herb. From the clinical and laboratory data, the patient was diagnosed with CHN caused by aristolochic acid.(Korean J Med 71:224-228, 2006)
참고문헌 (7)
- Vanherweghem J.L, "Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.", Lancet, 341, pp.387~391 (1993)
- Vanhaelen M, "Identification of aristolochic acid in Chinese herbs.", Lancet, 343, pp.174~ (1994)
- Gillerot G, "Aristolochic acid nephropathy in a Chinese patient: time to abandon the term "Chinese herbs nephropathy"?", Am J Kidney Dis, 38, pp.26~ (2001)
- Lebeau C, "Aristolochic acid impedes endocytosis and induces DNA adducts in proximal tubule cells.", Kidney Int, 60, pp.1332~1342 (2001)
- Schmeiser H.H, "Detection of DNA adducts formed by aristolochic acid in renal tissue from patients with Chinese herbs nephropathy.", Cancer Res, 56, pp.2025~2028 (1996)
- Bieler C.A, "32P-post- labelling analysis of DNA adducts formed by aristolochic acid in tissues from patients with Chinese herbs nephropathy.", Carcinogenesis, 18, pp.1063~1067 (1997)
- Debelle F.D, "Aristolochic acids induce chronic renal failure with interstitial fibrosis in salt-depleted rats.", J Am Soc Nephrol, 13, pp.431~436 (2002)