Update of aristolochic acid nephropathy in Korea
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. We collected data on cases of AAN since 1996 via a database in Korea. We evaluated th...
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Published in | The Korean journal of internal medicine Vol. 33; no. 5; pp. 961 - 969 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Korea (South)
The Korean Association of Internal Medicine
01.09.2018
대한내과학회 |
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Abstract | 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.
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.
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.
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. |
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AbstractList | 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. KCI Citation Count: 3 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. 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. 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. 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. |
Author | Han, Jin Suk Lee, Yu Ho Jeong, Kyung-Hwan Choi, Bum Soon Chung, Byung Ha Seo, Changhwan Yang, Chul Woo Lee, Sang-Ho Ban, Tae Hyun Kim, Da Rae Lee, Jae Wook Kim, Beom Seok Min, Ji-Won |
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Cites_doi | 10.1056/NEJM200006083422301 10.12771/emj.2007.30.2.101 10.1016/S0272-6386(00)70343-X 10.1002/ijc.28013 10.1016/S1470-2045(12)70596-X 10.1093/ndt/11.7.1359 10.1038/sj.ki.5002714 10.1016/S0140-6736(06)69079-X 10.1093/ndt/17.3.408 10.1038/ki.2008.129 10.1093/ndt/17.11.2033-a 10.1111/j.1440-1797.2012.01570.x 10.1016/S0140-6736(99)03380-2 10.1111/j.1440-1797.2003.00232.x 10.1080/19440049.2014.892215 10.1007/s40264-014-0244-x 10.1016/0140-6736(93)92984-2 10.1093/ndt/gfr291 10.7326/0003-4819-158-6-201303190-00006 10.1093/mutage/17.4.265 |
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Keywords | Chinese herbal medicine Aristolochic acid Renal toxicity |
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References | ref12 ref14 ref11 ref10 ref2 ref1 Jeong (ref17) 1996 ref16 Nam (ref18) 2000 Sung (ref21) 2006 ref24 ref23 ref26 ref25 ref22 Tanaka (ref9) 2000 ref28 ref27 ref8 ref7 Chau (ref13) 2011 ref4 ref3 ref6 Lee (ref20) 2006 ref5 Choi (ref19) 2003 Tazi (ref15) 2012 |
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Snippet | The true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain... Background/Aims: The true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to... |
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SubjectTerms | Aged Aristolochic Acids - adverse effects Drugs, Chinese Herbal - adverse effects Female Humans Kidney Failure, Chronic - chemically induced Male Original Republic of Korea - epidemiology 내과학 |
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Title | Update of aristolochic acid nephropathy in Korea |
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