Chinese herbs nephropathy presentation, natural history and fate after transplantation

Background. Chinese herbs nephropathy is a new type ofsubacute interstitial nephropathy reported in women who had followed aslimming regimen including Chinese herbs. Methods. Wereport the clinical presentation and follow-up of 15 cases and compare themwith a control group of 15 women with interstitial nephropathies of otherorigins, matched for age, sex, and initial serum creatinine (mean 3 mg/dl).Results. At presentation the Chinese herbs nephropathygroup differed from the control group by a lower proteinuria (P=0.009), amore severe anaemia (P=0.002), and a higher prevalence of aorticinsufficiency (42% vs 0%, P <0.005). It was further characterized bymild hypertension in 80%, glycosuria and leukocyturia in 40% and asymmetrickidneys in 43% of the cases. During follow-up, deterioration of renalfunction was faster in the Chinese herbs nephropathy than in the controlgroup (P <0.05). It was influenced by the duration of Chinese herbstreatment (P=0.037) and the delay between the end of Chinese herbsingestion and diagnosis of the disease (P-0.013). In three cases, renalfailure developed 3 years after Chinese herbs ingestion. Complicationsincluded severe aortic regurgitation requiring surgery (n=1), urothelialcarcinoma (n=2), bilateral ureterohydronephrosis due to periureteralfibrosis (n=1). Five patients with Chinese herbs nephropathy weresuccessfully transplanted, without evidence of recurrence of the disease.Conclusion. Chinese herbs nephropathy is characterizedby a lower proteinuria, more severe anaemia, and a faster progression ofrenal failure than other interstitial nephropathies. The duration ofChinese herbs treatment and interval between withdrawal of Chinese herbsand diagnosis are correlated with the rate of progression. Severe, unusualextrarenal complications may affect Chinese herbs nephropathy patients.