Chinese herbs nephropathy: not merely a trivial matter of a name

Abstract

A flood of protest against the term Chinese herbs nephropathy on the AJKD Discussion Forum has raised the question of the accuracy of this terminology. When my colleagues and I described this new renal disease for the first time, we were careful to be as close as possible to the description of the facts. We used the terms “regimen including Chinese herbs,”1Vanherweghem JL Depierreux M Tielemans C et al.Rapidly progressive interstitial renal fibrosis in young women: Association with slimming regimen including Chinese herbs.Lancet. 1993; 341: 387-391Google Scholar “aristolochic acids in Chinese herbs,”2Vanhaelen M Vanhaelen-Fastre R But P Vanherweghem JL Identification of aristolochic acid in Chinese herbs.Lancet. 1994; 343 (letter): 174Scopus (0) Google Scholar and “nephropathy related to the use of Chinese herbs.”3Depierreux M Van Damme B Vanden Houte K Vanherweghem JL Pathologic aspects of a newly described nephropathy related to the prolonged use of Chinese herbs.Am J Kidney Dis. 1994; 24: 172-180Google Scholar The name Chinese herbs nephropathy was used for the first time by Cosyns et al.4Cosyns JP Jadoul M Squifflet JP De Plaen JF Ferluga D Van Ypersele De Strihou C Chinese herbs nephropathy: A clue to Balkan endemic nephropathy?.Kidney Int. 1994; 45: 1680-1688Google Scholar Because this term seemed to meet the approval of nephrologists, we adopted it in our subsequent articles. The first dispute we had to face did not deal with the name of the disease but rather with questions about its reality. Promoters of Chinese herbal medicine claimed that the disease was related to “hidden substances” or to a Western misuse of Chinese herbs otherwise innocuous. After the accumulation of arguments favoring our hypothesis,5Schmeiser HH Bieler CA Wiessler M Van Ypersele De Strihou C Cosyns JP Detection of DNA adducts formed by aristolochic acid in renal tissue from patients with Chinese herbs nephropathy.Cancer Res. 1996; 56: 2025-2028Google Scholar, 6Vanherweghem JL Nephropathy and herbal medicine.Am J Kidney Dis. 2000; 35: 330-332Abstract Full Text Full Text PDF Scopus (23) Google Scholar, 7Nortier J Muniz Martinez MC Schmeiser HH et al.Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia Fangchi).N Engl J Med. 2000; 342: 1686-1692Google Scholar, 8Cosyns JP Dehoux JP Guiot Y et al.Chronic aristolochic acid toxicity in rabbits: A model of Chinese herb nephropathy?.Kidney Int. 2001; 59: 2164-2173Scopus (0) Google Scholar, 9Debelle FD Nortier J Deprez E et al.Aristolochic acids induce chronic renal failure with interstitial fibrosis in salt depleted rats.J Am Soc Nephrol. 2002; 13: 431-436Google Scholar the debate moved from science to policy: The term Chinese herbs nephropathy is racist. This is not the case. The cause of the nephropathy is the intake of herbs, not any herbs but herbs used in Traditional Chinese Medicine. Because (1) the term Chinese herbs is recognized, (2) humans are not exposed to aristolochic acids except through herbal medicine, and (3) the U.S. Food and Drug Administration has depicted at least 84 Chinese herbs containing aristolochic acids,10Lewis CJ Alpert S Letter to health care professionals on FDA concerned about botanical products, including dietary supplements containing aristolochic acid.US Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Nutritional Products, Labeling and Dietary Supplements, May 31, 2000. National Institutes of Health, Bethesda, MD2000Google Scholar the general term Chinese herbs nephropathy should continue to be used as a practical signal for clinicians.