Yang C S, Lin C H, Chang S H, Hsu H C
Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
Am J Kidney Dis. 2000 Feb;35(2):313-8. doi: 10.1016/s0272-6386(00)70343-x.
Rapidly progressive fibrosing interstitial nephritis after a slimming regimen containing aristolochic acid has been identified as Chinese herbs nephropathy (CHNP). From 1995 to 1998, we observed 12 Chinese people from different areas of Taiwan who underwent renal biopsy for unexplained renal failure. Medical history gave no clue to the causes of impaired renal function except for the ingestion of traditional Chinese herbs. Although these patients ingested herbal drugs from various sources for different purposes, their renal biopsy samples showed amazingly similar histological findings, with extensive hypocellular interstitial fibrosis and atrophy and loss of tubules in all cases. Glomeruli were apparently intact. They also had similar clinical features, such as normal or mildly elevated blood pressure, early and severe anemia, low-grade proteinuria, glycosuria, and insignificant urinary sediments. Renal function deteriorated rapidly in most patients despite discontinuation of the herbal medicines. Seven patients underwent dialysis, and the remainder experienced slowly progressive renal failure. Bladder carcinoma was found in one patient. Morphologically and clinically, the nephropathy in our patients was similar to CHNP, reported in Belgium. Because of the complexity and unknown types of herbs used in different clinical situations, unidentified phytotoxins other than aristolochic acid might be responsible for this unique disease entity. We conclude that the relation of this nephropathy to the consumption of Chinese herbs is striking. Using uncontrolled herbal remedies carries a high risk for developing interstitial renal fibrosis and urothelial malignancy.
在服用含马兜铃酸的减肥疗法后出现的快速进展性纤维化间质性肾炎已被认定为中草药肾病（CHNP）。1995年至1998年，我们观察了12名来自台湾不同地区因不明原因肾衰竭接受肾活检的中国人。除了服用过传统中草药外，病史未提示肾功能损害的原因。尽管这些患者因不同目的服用了来源各异的草药，但他们的肾活检样本显示出惊人相似的组织学表现，所有病例均有广泛的细胞减少性间质纤维化以及肾小管萎缩和丧失。肾小球明显完整。他们也有相似的临床特征，如血压正常或轻度升高、早期严重贫血、轻度蛋白尿、糖尿以及尿沉渣不显著。尽管停用了草药，大多数患者的肾功能仍迅速恶化。7名患者接受了透析，其余患者则经历了缓慢进展的肾衰竭。1名患者发现患有膀胱癌。从形态学和临床角度来看，我们患者的肾病与比利时报道的CHNP相似。由于不同临床情况下使用的草药种类复杂且不明，除马兜铃酸外的未知植物毒素可能是导致这种独特疾病实体的原因。我们得出结论，这种肾病与食用中草药之间的关联十分显著。使用未受控制的草药疗法会有发生间质性肾纤维化和尿路上皮恶性肿瘤的高风险。
