Urothelial lesions in Chinese-herb nephropathy
Urothelial lesions in Chinese-herb nephropathy
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DOI：
10.1016/s0272-6386(99)70136-8
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发表时间：
1999-06-01
影响因子：
13.2
通讯作者：
de Strihou, CV
中科院分区：
文献类型：
--
作者：
Cosyns, JP;Jadoul, M;de Strihou, CV
中药肾病是一种在使用含马兜铃酸（AA）的中药减肥后发生的快速进展性肾纤维化。我们报告了3例CHN患者的尿路上皮增生，1例患者随后发展为明显的移行细胞癌（ICC），因此，决定在所有CHN患者中切除自体肾脏和输尿管，19个肾脏和输尿管在和/或对10名患者的肾移植后进行研究，以评估严重的尿路上皮病变并表征p53的细胞表达，在几种恶性肿瘤中过度表达的肿瘤抑制基因。在4名患者中观察到多灶性高级别扁平原位TCC（原位癌; CIS），主要发生在上尿路，患病率为40%。在其中一名患者中，分别在右肾盂和左输尿管下段发现了右上输尿管的浅表侵袭性扁平TCC以及两个额外的非侵袭性乳头状TCC病灶。该患者还表现为复发性非侵袭性膀胱乳头状TCC。此外，在所有病例中，在髓质集合管、肾盂和输尿管中发现多灶性、总体中度的膀胱炎，所有CIS和乳头状TCC以及尿路上皮膀胱炎，p53过表达。这些结果表明，摄入含有AA的中药具有显著的致癌作用。癌变与p53的过度表达有关，这表明p53基因突变的作用。这种突变与肾脏中AA DNA加合物的报告存在的关系仍有待探讨。(C)1999年由国家肾脏基金会，公司。
Rapidly progressive renal fibrosis after a slimming regimen including Chinese herbs containing aristolochic acid (AA) has been identified as Chinese-herb nephropathy (CHN). We reported urothelial atypia in three patients with CHN, with the subsequent development in one patient of overt transitional cell carcinoma (ICC), Therefore, it was decided to remove the native kidneys, as well as the ureters, in all patients with CHN, Nineteen kidneys and ureters removed during and/or after renal transplantation from 10 patients were studied to assess critically urothelial lesions and to characterize the cellular expression of p53, a tumor-suppressor gene overexpressed in several types of malignancies. Multifocal high-grade flat TCC in situ (carcinoma in situ; CIS) was observed, mainly in the upper urinary tract, in four patients, a prevalence of 40%. In one of those patients, a superficially invasive flat TCC of the right upper ureter, as well as two additional foci of noninvasive papillary TCC, were found in the right pelvis and left lower ureter, respectively. This patient also presented recurrent noninvasive papillary TCC of the bladder. Furthermore, in all cases, multifocal, overall moderate atypia was found in the medullary collecting ducts, pelvis, and ureter, All CIS and papillary TCC, as well as urothelial atypia, overexpressed p53, These results show that the intake of Chinese herbs containing AA has a dramatic carcinogenic effect. Carcinogenesis is associated with the overexpression of p53, which suggests a role for a p53 gene mutation. The relationship of this mutation with the reported presence of AA DNA adducts in the kidney remains to be explored. (C) 1999 by the National Kidney Foundation, Inc.