Korean J Intern Med.  2018 Sep;33(5):961-969. 10.3904/kjim.2016.288.

Update of aristolochic acid nephropathy in Korea

• Ban TH
• Min JW
• Seo C
• Kim DR
• Lee YH
• Chung BH
• Jeong KH
• Lee JW
• Kim BS
• Lee SH
• Choi BS
• Han JS
• Yang CW

• KMID: 2420008
• DOI: http://doi.org/10.3904/kjim.2016.288

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.

Keyword

Chinese herbal medicine; Aristolochic acid; Renal toxicity

MeSH Terms

Acute Kidney Injury
Adult
Chronic Disease
Diagnosis
Fanconi Syndrome
Female
Health Promotion
Herbal Medicine
Hospitalization
Humans
Incidence
Kidney Failure, Chronic
Korea*
Medicine, East Asian Traditional
Medicine, Traditional
Nausea
Organization and Administration
Postpartum Period
Prognosis
United States Food and Drug Administration
Vomiting