Does Chinese Herb Nephropathy Account for the High Incidence of End-Stage Renal Disease in Taiwan?

Abstract

Background: The incidence of end-stage renal disease (ESRD) in Taiwan ranks highest in the world, but the incidence of Chinese herb nephropathy (CHN) is unknown in this country where Chinese herb use is common. Methods: The etiologies of incident ESRD cases from 2000 to 2004 in a single tertiary referral medical center in Taiwan were independently reviewed by two nephrologists through medical records and telephone interview. Patients with obvious causes of ESRD were not diagnosed with CHN, in spite of Chinese herb use. Three categories of CHN (A, B and C) were defined according to the stringency of evidence. Results: Obvious causes of ESRD were identified in 1,359 out of 1,696 newly diagnosed ESRD patients. Among the remainders, 263 had histories of Chinese herb use; 164 patients (mean age 52.7 ± 13.2 years, female 71.6%) had CHN (category A: 51, category B: 38 and category C: 75). Among the three categories, there was no difference in age, gender, body mass index (BMI) or elapsed time from Chinese herb use to the detection of renal failure. In comparison with non-CHN patients (n = 99), more CHN patients were female, had lower BMI, lower blood pressure, shorter duration of Chinese herb use, less severe proteinuria, smaller kidney size, lower levels of hemoglobin and higher serum chloride levels (all p values <0.01). Conclusion: Based on highly stringent diagnostic criteria, nearly 10% of incident ESRD cases were due to CHN. CHN represents a significant cause of ESRD in Taiwan.

Systematic Overview of Aristolochic Acids: Nephrotoxicity, Carcinogenicity, and Underlying Mechanisms

“…Long-term ingestion of herbal formula known or suspected to contain AAs is one of the prominent risk factors for developing AAN (Jia et al, 2005; Vervaet et al, 2017). Although the sale and use of AA-containing products are banned or restricted in most of the countries (Krell and Stebbing, 2013), AAN induced by numerous herbal remedies and products are still reported from all over the world (Lord et al, 1999; Yang et al, 2006; Debelle et al, 2008; Shaohua et al, 2010; Wu et al, 2012; Vaclavik et al, 2014; Ban et al, 2018).…”

Chronic Kidney Disease is Associated With Upper Tract Urothelial Carcinoma

“…27 More female Chinese herbal nephropathies have been diagnosed. 28 In the study by Chang et al, the authors report that the use of Chinese herbs, especially if they contain aristolochic acid or compound analgesics, may contribute to the development of urothelial carcinoma. 29 A population-based study also revealed that the use of aristolochic acid-containing Chinese herbal products is associated with a dose-dependent increased risk of urinary tract cancer.…”

Aristolochic Acid and Immunotherapy for Urothelial Carcinoma: Directions for unmet Needs

“…Currently known as aristolochic acid nephropathy [16], this endemic disease may not only result in end-stage renal disease (ESRD), but also UTUC [8,17,18,19]. Therefore, it is no surprise that a consistent linkage between ESRD patients and their increased urothelial carcinoma (UC) risks has been repeatedly reported in AA-endemic area [20,21], with a general sequential order being UC after ESRD [22,23].…”