London and Birmingham, United Kingdom

Correspondence: Han Y. Chen, M.D., Herbal Care Clinic, 161 High Street North, London E6, UK. E-mail: hychen@tinyonline.co.uk

To the Editor: We were alarmed to see the article by Cosyns et al in a recent issue of Kidney International in which the term "Chinese herbs nephropathy" (CHN) was used¹. In the Discussion Forum of the American Journal of Kidney Diseases (http://www.ajkd.org) we have strongly disputed the use of this description. Our arguments are as follows.

"Chinese herbs nephropathy" is a very prejudicial term. The incorrect use of Aristolochia fangchi by Belgian practitioners² and nephritis induced by Cosyns et al¹ suggest that aristolochic acid is possibly associated with nephropathy. Many hundreds of Chinese medicinal herbs are safely used in China and throughout the world. The Encyclopaedia of Traditional Chinese Medicinal Substances documents 5767 entries, mostly botanical substances³. Many herbs and their combinations are used to treat nephritis in Chinese hospitals. The term CHN may imply to readers that Chinese herbs in general cause renal impairment.

Furthermore, the nomenclature of medical terms involving a specific nation needs to be carefully scrutinized. For instance, mongolism was replaced by Down's syndrome and "Malta fever" by Brucellosis. Australia antigen was designated as hepatitis B surface antigen. Indeed, any medical terms and statements tending to encourage prejudice and racism should be abandoned⁴. We feel strongly that the term CHN, which is etiologically misleading and politically damaging, should follow suit.

We therefore hope that a reputable journal such as Kidney International will play a leading role in adopting nonprejudicial medical terms, specifically using aristolochic acid-associated nephropathy (AAN) rather than CHN in the furure.