Update of aristolochic acid nephropathy in Korea
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Background/Aims: The true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain aristolochic acid (AA) are used in traditional medicine in Korea. Methods: We collected data on cases of AAN since 1996 via a database in Korea. We evaluated the year of AAN development, route to obtaining AA-containing herbal medicine, gender, reason for taking AA-containing herbal medicine, clinical manifestations, histological findings, phytochemical analysis, and prognosis of patients with AAN. Results: Data on 16 cases of AAN were collected. Thirteen cases developed AAN before and three cases after the prohibition of AA-containing herbal medicine by the Korea Food and Drug Administration. Patients were prescribed AA-containing herbal medicine from oriental clinics or had purchased it from traditional markets. AAN was distributed in all age groups. Young females were most commonly exposed to AA-containing herbal medicine for slimming purposes and postpartum health promotion, while older adults took AA-containing compounds for the treatment of chronic diseases. The most common symptoms presented at hospitalization were nausea and vomiting, and acute kidney injury was accompanied by Fanconi syndrome in almost half of the patients. Phytochemical analysis of AA in herbal medicine was available in six cases. Progression to end stage renal disease (ESRD) was observed in seven patients (43.8%), and five patients (31.3%) had progressed to ESRD within 6 months of diagnosis. Conclusions: Our report shows that patients were still exposed to AA-containing herbal medicine and that there is a possibility of underdiagnosis of AAN in Korea. A stronger national supervision system of herbal ingredients and remedies in oriental medicine is needed to prevent AAN.
Abstract
Background/Aims: The true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain aristolochic acid (AA) are used in traditional medicine in Korea. Methods: We collected data on cases of AAN since 1996 via a database in Korea. We evaluated the year of AAN development, route to obtaining AA-containing herbal medicine, gender, reason for taking AA-containing herbal medicine, clinical manifestations, histological findings, phytochemical analysis, and prognosis of patients with AAN. Results: Data on 16 cases of AAN were collected. Thirteen cases developed AAN before and three cases after the prohibition of AA-containing herbal medicine by the Korea Food and Drug Administration. Patients were prescribed AA-containing herbal medicine from oriental clinics or had purchased it from traditional markets. AAN was distributed in all age groups. Young females were most commonly exposed to AA-containing herbal medicine for slimming purposes and postpartum health promotion, while older adults took AA-containing compounds for the treatment of chronic diseases. The most common symptoms presented at hospitalization were nausea and vomiting, and acute kidney injury was accompanied by Fanconi syndrome in almost half of the patients. Phytochemical analysis of AA in herbal medicine was available in six cases. Progression to end stage renal disease (ESRD) was observed in seven patients (43.8%), and five patients (31.3%) had progressed to ESRD within 6 months of diagnosis. Conclusions: Our report shows that patients were still exposed to AA-containing herbal medicine and that there is a possibility of underdiagnosis of AAN in Korea. A stronger national supervision system of herbal ingredients and remedies in oriental medicine is needed to prevent AAN.
참고문헌 (28)
- Debelle FD, "Aristolochic acid nephropathy: a worldwide problem", Kidney Int, 74, pp.158~169 (2008)[DOI]
- Krell D, "Aristolochia: the malignant truth", Lancet Oncol, 14, pp.25~26 (2013)[DOI]
- Vanherweghem JL, "Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs", Lancet, 341, pp.387~391 (1993)[DOI]
- Nortier JL, "Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi)", N Engl J Med, 342, pp.1686~1692 (2000)[DOI]
- Arlt VM, "Aristolochic acid as a probable human cancer hazard in herbal remedies: a review", Mutagenesis, 17, pp.265~277 (2002)[DOI]
- Gokmen MR, "The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review", Ann Intern Med, 158, pp.469~477 (2013)[DOI]
- Pena JM, "Rapidly progressive interstitial renal fibrosis due to a chronic intake of a herb (Aristolochia pistolochia) infusion", Nephrol Dial Transplant, 11, pp.1359~1360 (1996)[DOI]
- Lord GM, "Nephropathy caused by Chinese herbs in the UK", Lancet, 354, pp.481~482 (1999)[DOI]
- Tanaka A, "Chinese herb nephropathy in Japan presents adult-onset Fanconi syndrome: could different components of aristolochic acids cause a different type of Chinese herb nephropathy?", Clin Nephrol, 53, pp.301~306 (2000)
- Yang CS, "Rapidly progressive fibrosing interstitial nephritis associated with Chinese herbal drugs", Am J Kidney Dis, 35, pp.313~318 (2000)[DOI]
- Lee S, "Fanconi's syndrome and subsequent progressive renal failure caused by a Chinese herb containing aristolochic acid", Nephrology (Carlton), 9, pp.126~129 (2004)[DOI]
- Laing C, "Chinese herbal uropathy and nephropathy", Lancet, 368, pp.338~ (2006)[DOI]
- Chau W, "Nephropathy associated with use of a Chinese herbal product containing aristolochic acid", Med J Aust, 194, pp.367~368 (2011)
- Hutton H, "Acute renal failure due to an aristolochic acid containing herbal remedy", Nephrology (Carlton), 17, pp.522~523 (2012)[DOI]
- Tazi I, "Fatal renal failure due to self administration of Aristolochia Longa after treatment with chemotherapy", Arab J Nephrol Transplant, 5, pp.54~ (2012)
- Vaclavik L, "Quantification of aristolochic acids I and II in herbal dietary supplements by ultra-high-performance liquid chromatography-multistage fragmentation mass spectrometry", Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 31, pp.784~791 (2014)[DOI]
- Jeong HJ, "Nephropathies associated with herb medicine ingestion", Kidney Res Clin Pract, 15, pp.365~372 (1996)
- Nam KD, "A case of Chinese herbs nephropathy", Korean J Nephrol, 19, pp.751~755 (2000)
- 최창렬, "Fanconi 증후군으로 발현한Chinese Herb Nephropathy 1예-서양형과 동양형의 차이 비교-", Kidney Research and Clinical Practice, 22(1), pp.118~123 (2003), 대한신장학회
- 이재욱, "광방기에 의해 발생한 Chinese Herb Nephropathy 1예", 대한내과학회지, 71(2), pp.224~228 (2006), 대한내과학회
- 성혜영, "미세변화증후군 환자에서 말기신부전으로 진행한 Chinese herb nephropathy 1예", Kidney Research and Clinical Practice, 25(1), pp.99~102 (2006), 대한신장학회
- Won HS, "A case of Fanconi's syndrome due to Chinese herb nephropathy", Ewha Med J, 30, pp.101~105 (2007)[DOI]
- Luciano RL, "Aristolochic acid nephropathy: epidemiology, clinical presentation, and treatment", Drug Saf, 38, pp.55~64 (2015)[DOI]
- Pozdzik AA, "Aristolochic acid induces proximal tubule apoptosis and epithelial to mesenchymal transformation", Kidney Int, 73, pp.595~607 (2008)[DOI]
- Martinez MC, "Progression rate of Chinese herb nephropathy: impact of Aristolochia fangchi ingested dose", Nephrol Dial Transplant, 17, pp.408~412 (2002)[DOI]
- Yang L, "Aristolochic acid nephropathy: variation in presentation and prognosis", Nephrol Dial Transplant, 27, pp.292~298 (2012)[DOI]
- Chen CH, "Aristolochic acid-induced upper tract urothelial carcinoma in Taiwan: clinical characteristics and outcomes", Int J Cancer, 133, pp.14~20 (2013)[DOI]
- Martinez MC, "Steroid therapy in chronic interstitial renal fibrosis: the case of Chinese-herb nephropathy", Nephrol Dial Transplant, 17, pp.2033~2034 (2002)[DOI]