“Chinese herbal uropathy and nephropathy”?

Abstract

In their Case Report (July 22, p 338), Chris Laing and colleagues1Laing C Hamour S Sheaff M Miller R Woolfson R Chinese herbal uropathy and nephropathy.Lancet. 2006; 368: 338Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar relate the development of cancer and renal failure to having taken long dan xie gan wan without showing that the patient had aristolochic-acid-related DNA adducts in the tissues.2Cosyns JP Aristolochic acid and ‘Chinese herbs nephropathy’: a review of the evidence to date.Drug Saf. 2003; 26: 33-48Crossref PubMed Scopus (247) Google Scholar Aristolochic acid containing herbs was banned worldwide as an ingredient in Chinese medicines in 2001. The case report did not present any evidence that the long dan xie gan wan taken by the patient contained any aristolochic acid. We have several other concerns. First, long dan xie gan wan is used in Chinese medicine to “drain liver-gallbladder replete heat”.3Flaw B 160 essential Chinese herbal patent medicines. 1st edn. Blue Poppy Press, Boulder, CO1999: 53Google Scholar It is extremely unusual and doubtful that a healthy person would have taken it for 5 successive years “to enhance the liver”. Second, interstitial fibrosis is a non-specific morphological change in the kidney. It can be associated with the use of various analgesics, antimicrobial agents, non-steroidal anti-inflammatory drugs, and diuretics4Davison AM Cameron JS Grünfeld J-P Kerr DNS Ritz E Winearls CG Oxford textbook of clinical nephrology. 2nd edn. Oxford Medical Publications, Oxford1998: 1638Google Scholar as well as with ingestion of aristolochic acid. Third, some references Laing and colleagues cite, such as the one from a newspaper, are based on supposition. Finally, the title “Chinese herbal uropathy and nephropathy” is unscientific and unfair: the nephropathy associated with aristolochic acid should no longer be related to Chinese herbal medicines because they are no longer permitted to contain it.2Cosyns JP Aristolochic acid and ‘Chinese herbs nephropathy’: a review of the evidence to date.Drug Saf. 2003; 26: 33-48Crossref PubMed Scopus (247) Google Scholar, 5Chen HY Ma B-Y Grant A Time to abandon the term “Chinese herbs nephropathy”.Kidney Int. 2001; 60: 2039-2040Crossref PubMed Scopus (12) Google Scholar We declare that we have no conflict of interest. “Chinese herbal uropathy and nephropathy”? – Authors' replyAt each clinic attendance, our patient was interviewed with the help of a professional Chinese interpreter. The history as given was confirmed on several occasions. He took long dan xie gan wan, which was purchased in China, to “enhance his liver” for a period of 5 years commencing in 1995 and we were able to inspect packets of this preparation. No other drug history was ascertained from the patient. Full-Text PDF