Vol. 9, No 1, 2002 pp. 49 - 52
UC 616.61-004
HUMAN AND EXPERIMENTAL FEATURES OF ARISTOLOCHIC
ACID NEPHROPATHY (AAN; FORMERLY CHINESE HERBS NEPHROPATHY - CHN): ARE THEY
RELEVANT TO BALKAN ENDEMIC NEPHROPATHY (BEN)?
Jean-Pierre Cosyns
Université Catholique de Louvain, Cliniques universitaires St-Luc,
Department of Pathology, Brussels, Belgium
E-mail: cosyns@anps.ucl.ac.be
Summary. Chinese herbs nephropathy, a rapidly progressive interstitial
nephropathy, has been reported in young Belgian women given a slimming
regimen including Chinese herbs. It is characterized by early, severe anemia,
mild tubular proteinuria, and normal arterial blood pressure. Renal histology
shows an extensive, remarkably a- or hypo-cellular interstitial fibrosis
associated with tubular atrophy and global sclerosis of glomeruli with
a decreasing cortico-medullary gradient. A 40% to 46% prevalence of upper
urothelial malignancy of the upper urinary tract has been reported.
The nephrotoxic and carcinogenic aristolochic acids (AAs), extracted
from the Aristolochia species, have been identified in herbs included in
the slimming pills. The hypothesis that these alkaloids were the cause
of CHN was substantiated by the identification of pre-mutagenic AA-DNA
adducts in the kidney tissue of CHN patients. The causal role of AAs in
CHN has eventually been demonstrated by the induction of the salient biologic
and morphologic features of CHN in rabbits fed pure AAs without other components
of the slimming regimen.
Biological and morphological features of human and experimental AA-induced
nephropathy are strikingly similar to those reported in BEN suggesting
that AAs play also an etiological role in BEN, a hypothesis considered
many years ago and yet to be fully explored. Confirmation of this hypothesis
requires evidence that patients with an unequivocal diagnosis of BEN have
ingested foods containing AAs and harbour AA-DNA adducts in their renal
tissue.
Key words: Balkan endemic nephropathy, Chinese herbs nephropathy,
aristolochic acid nephropathy, interstitial nephropathy, urothelial cancer
