Aristolochic Acid Induced Fanconi's Syndrome

Shin, Hyun Phil; Lee, Tae Won; Lee, Young Jae; Lee, Sang Ho; Ihm, Chun Gyoo; Kim, Myung Jae

Abstract

A unique type of rapidly progressive interstitial fibosis of the kidney designated Chinese herb nephropathy (CHN) has been reported in Belgian woman after intake of Chinese herbs. CHN contains variable clinical features from progressive renal failure with severe anemia to adult-onset Fanconi's syndrome which have been reported mostly in Asian countries. We are reporting a case of 43 years-old female patient. The patient visited our hospital with symptoms of polyuria, polydipsia and generalized weakness and laboratory investigation showed hypokalemia, hyperchloremic metabolic acidosis, hypophosphatemia consitent with Fanconis's syndrome. We found out her intake of Chinese herbal mixture by history taking. The Fanconi's syndrome seemed to be revrersible but it progressed to renal failure after four months in spite of only ten days intake. Renal biopsy resulted typical findings of aristolochic acid induced nephrophathy. Aristolochic acids were also detected in herbal mixture by high performance chromatography. This case shows variable clinical course of aristolochic acid-induced nephrophathy. It is important to bear in mind that CHN could present variable clinical pattern and herbal mixture that include aristolochic acid should be avoided.