No Incidence of Liver Cancer Was Observed in A Retrospective Study of Patients with Aristolochic Acid Nephropathy / 中国结合医学杂志

OBJECTIVE@#To assess the risk of aristolochic acid (AA)-associated cancer in patients with AA nephropathy (AAN).@*METHODS@#A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014. Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer. The primary endpoint was the incidence of liver cancer, and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.@*RESULTS@#A total of 337 patients diagnosed with AAN were included in this study. From the initiation of taking AA to the termination of follow-up, 39 patients were diagnosed with cancer. No cases of liver cancer were observed throughout the entire follow-up period, with urinary cancer being the predominant type (34/39, 87.17%). Logistic regression analysis showed that age, follow-up period, and diabetes were potential risk factors, however, the dosage of the drug was not significantly associated with urinary cancer.@*CONCLUSIONS@#No cases of liver cancer were observed at the end of follow-up. However, a high prevalence of urinary cancer was observed in AAN patients. Establishing a direct causality between AA and HCC is challenging.

Reversible acute renal failure due to Chinese herbs

Recently, herb induced nephropathy has been described as a subgroup of renal disorders. Patients taking Chinese herbs for eczema and weight reduction have been reported to develop chronic interstitial nephritis, rapidly progressive interstitial fibrosis and urothelial malignancies. An agent, known as aristolochic acid [AA], isolated from such herbs has been identified as an independent and direct nephrotoxin. The pathology by which AA incurs renal damage is yet to be determined. With regards to malignancies triggered by such herbs, these patients have been found to over express a mutated p53 gene. Here, we discuss the management of a young female patient who developed biopsy proven acute interstitial nephritis with early fibrosis after ingesting a herbal remedy for a short period of time. Other causes of interstitial nephritis in this patient such as viral infections and autoimmune disorders were investigated and ruled out. Initially, she presented with acute renal failure requiring hemodialysis for ten days. Fortunately, she did not develop any permanent renal dysfunction as the etiology was identified early and the herbs were discontinued immediately. Her renal impairment reversed to normal within a one-month period after a trial of corticosteroids was administered. We believe this is the first of such cases isolated in Saudi Arabia