M. Refik Gökmen, PhD, MA, MBBS; Jean-Pierre Cosyns, MD, PhD; Volker M. Arlt, PhD; Marie Stiborová, PhD; David H. Phillips, PhD, DSc; Heinz H. Schmeiser, PhD; Monique S.J. Simmonds, PhD; H. Terence Cook, MBBS; Jean-Louis Vanherweghem, MD, PhD; Joëlle L. Nortier, MD, PhD; Graham M. Lord, MD, PhD, MA
Disclaimer: The views expressed are those of the authors and are not necessarily those of the U.K. National Health Service (NHS), the National Institute for Health Research (NIHR), or the Department of Health.
Acknowledgment: The authors thank Professor Dusan Ferluga and Dr. Alenka Vizjak for the histologic image of BEN.
Financial Support: The preparation of this review was supported in part by a project grant from the Association for International Cancer Research. Dr. Gökmen is supported by an NIHR Clinical Lectureship and was previously supported by Kidney Research UK. Drs. Gökmen and Lord are supported by the NIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. Drs. Arlt and Phillips are supported by Cancer Research UK.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1902.
Requests for Single Reprints: Graham M. Lord, MD, PhD, MA, Department of Experimental Immunobiology, Division of Transplantation Immunology and Mucosal Biology, King's College London, 5th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Gökmen and Lord: Department of Experimental Immunobiology, Division of Transplantation Immunology and Mucosal Biology, King's College London, 5th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom.
Dr. Cosyns: Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Department of Pathology (Tour Franklin-1), 10 Avenue Hippocrate, 200 Brussels, Belgium.
Drs. Arlt and Phillips: Analytical and Environmental Sciences Division, MRC-HPA Centre for Environment & Health, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom.
Dr. Stiborová: Department of Biochemistry, Faculty of Science, Charles University, Albertov 2030, 128 40 Prague 2, Czech Republic.
Dr. Schmeiser: Research Group Genetic Alterations in Carcinogenesis, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
Dr. Simmonds: Director Kew Innovation Unit, Royal Botanic Gardens, Kew, Surrey TW9 3AB, United Kingdom.
Dr. Cook: Professor of Renal Pathology, Department of Medicine, Imperial College, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom.
Drs. Vanherweghem and Nortier: Department of Nephrology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
Author Contributions: Conception and design: M.R. Gökmen, V.M. Arlt, M. Stiborová, H.H. Schmeiser, M.S.J. Simmonds, G.M. Lord.
Analysis and interpretation of the data: M.R. Gökmen, J.P. Cosyns, D.H. Phillips, H.H. Schmeiser, M.S.J. Simmonds, J.L. Vanherweghem, J.L. Nortier, G.M. Lord.
Drafting of the article: M.R. Gökmen, J.P. Cosyns, V.M. Arlt, D.H. Phillips, H.T. Cook, J.L. Vanherweghem, G.M. Lord.
Critical revision of the article for important intellectual content: J.P. Cosyns, V.M. Arlt, H.H. Schmeiser, M.S.J. Simmonds, H.T. Cook, J.L. Vanherweghem, J.L. Nortier, G.M. Lord.
Final approval of the article: M.R. Gökmen, J.P. Cosyns, V.M. Arlt, M. Stiborová, D.H. Phillips, H.H. Schmeiser, M.S.J. Simmonds, H.T. Cook, J.L. Vanherweghem, J.L. Nortier, G.M. Lord.
Administrative, technical, or logistic support: M.R. Gökmen.
Collection and assembly of data: M.R. Gökmen, J.P. Cosyns, M.S.J. Simmonds, J.L. Vanherweghem, G.M. Lord.
Gökmen M., Cosyns J., Arlt V., Stiborová M., Phillips D., Schmeiser H., Simmonds M., Cook H., Vanherweghem J., Nortier J., Lord G.; The Epidemiology, Diagnosis, and Management of Aristolochic Acid Nephropathy: A Narrative Review. Ann Intern Med. 2013;158:469-477. doi: 10.7326/0003-4819-158-6-201303190-00006
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Published: Ann Intern Med. 2013;158(6):469-477.
It has been 20 years since the first description of a rapidly progressive renal disease that is associated with the consumption of Chinese herbs containing aristolochic acid (AA) and is now termed aristolochic acid nephropathy (AAN). Recent data have shown that AA is also the primary causative agent in Balkan endemic nephropathy and associated urothelial cancer. Aristolochic acid nephropathy is associated with a high long-term risk for renal failure and urothelial cancer, and the potential worldwide population exposure is enormous. This evidence-based review of the diagnostic approach to and management of AAN draws on the authors' experience with the largest and longest-studied combined cohort of patients with this condition. It is hoped that a better understanding of the importance of this underrecognized and severe condition will improve epidemiologic, preventive, and therapeutic strategies to reduce the global burden of this disease.
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