CHINESE HERBS NEPHROPATHY - A CLUE TO BALKAN ENDEMIC NEPHROPATHY

Rapidly progressive interstitial renal fibrosis has recently been repo rted in young women who have been on a slimming regimen including Chin ese herbs. We examined four nephroureterectomies performed in three pa tients prior to or at the time of transplantation to determine the nat ure and topography of the kidney and urinary tract lesions in Chinese herbs nephropathy (CHN). Extensive, hypocellular, interstitial scleros is, tubular atrophy and global sclerosis of glomeruli decreasing from the outer to the inner cortex, including the columns of Bertin, were o bserved in the four kidney specimens, together with severe fibromucoid to fibrous intimal thickening, mainly of interlobular arteries, norma l or collapsed residual glomeruli, and mild to moderate atypia and aty pical hyperplasia of the urothelium. In addition, bilateral pelviurete ric sclerosis was observed in one case. With the exception of the latt er, these lesions are very similar to those described in Balkan endemi c nephropathy (BEN). The clinical presentation of the patients was als o similar to that observed in BEN: normal blood pressure, aseptic leuk ocyturia, low grade low molecular weight proteinuria, early and severe anemia. In conclusion, on morphological and clinical grounds, CHN app ears similar to BEN. A common etiologic agent, aristolochic acid, is s uspected. The known carcinogenic potential of this compound, taken tog ether with our finding of multiple foci of cellular atypia of the urot helium suggest that CHN patients should undergo a regular follow-up fo r urothelial malignancy.