The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Update of aristolochic acid nephropathy in Korea

  • Ban, Tae Hyun (Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Min, Ji-Won (Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Seo, Changhwan (Department of Internal Medicine, The Research Institute for Transplantation, and Institute of Kidney Disease Research, Yonsei University College of Medicine) ;
  • Kim, Da Rae (Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine) ;
  • Lee, Yu Ho (Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine) ;
  • Chung, Byung Ha (Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Kyung-Hwan (Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine) ;
  • Lee, Jae Wook (Nephrology Clinic, National Cancer Center Hospital) ;
  • Kim, Beom Seok (Department of Internal Medicine, The Research Institute for Transplantation, and Institute of Kidney Disease Research, Yonsei University College of Medicine) ;
  • Lee, Sang-Ho (Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine) ;
  • Choi, Bum Soon (Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Han, Jin Suk (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Yang, Chul Woo (Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2016.09.26
  • Accepted : 2016.11.08
  • Published : 2018.09.01
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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.

Keywords

Acknowledgement

Supported by : Ministry for Health and Welfare

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