Chinese herbal uropathy and nephropathy.

摘要

In July, 2003, a 30-year-old Chinese man was referred to our outpatients department. He had reported macroscopic haematuria to his family physician, who confirmed haematuria on urine dipstick; his blood tests at that time showed a high serum creatinine concentration (200 umol/L). He was then referred to our nephrology clinic. There were no other symptoms or medical history and no family history of renal disease. For at least 5 years, he had been taking the Chinese herb Longdan Xieganwan to "enhance" his liver. He was normotensive, and physical examination was unremarkable. Nephritic screen and urine culture were negative with normal renal-tract ultrasonography.A few days after his initial assessment, he returned to clinic with a large fragment of solid material that he had passed per urethram. Histopathology showed a mass of transitional-cell carcinoma cells. Urgent cystoscopy showed a limited bladder tumour, which was resected. There was no extravesical extension of tumour on pelvic CT, and he received intravesical chemotherapy. Despite avoidance of Chinese herbs, he has developed recurrent transitional-cell carcinomas in the bladder, which have been treated by repeated cystoscopic resection; he has declined cystectomy. A renal biopsy done in April, 2004, showed interstitial fibrosis consistent with Chinese herbal nephropathy (figure). He has progressed to end-stage renal failure, and when seen in June, 2006, was preparing for renal replacement therapy.