Brussels, Belgium

Correspondence: Jean-Pierre Cosyns, M.D., Ph.D., Department of Pathology, ANPS 1712, Université Catholique de Louvain, Medical School, Cliniques Universitaires St-Luc, 10 Avenue Hippocrate, B-1200 Brussels, Belgium. E-mail: cosyns@anps.ucl.ac.be

To the Editor: In their letter entitled "Time to abandon the term 'Chinese herbs nephropathy'" in the November issue of Kidney International, Dr. Chen et al argue against continuing to use the term "Chinese herbs nephropathy" to describe the rapidly progressive sclerosing interstitial nephropathy observed in women given Chinese herbs for slimming purposes¹.

In a recent case report published in the electronic Website edition of the November issue of American Journal of Kidney Disease, we demonstrated that aristolochic acid (AA) taken in China in an herbal remedy induces a typical Chinese herbs nephropathy (CHN) with AA-DNA adducts and urothelial lesions². Furthermore, AA given alone to rabbits induces similar renal and urothelial lesions³. The causal role of AA in the Belgian epidemy and in at least one Chinese patient is thus established. We have proposed to use the term "aristolochic acid nephropathy" in those cases in which there is unequivocal demonstration of AA intoxication.

Second, in a Letter to the Editor in the same issue of American Journal of Kidney Disease, Solez et al commented on Dr. Chen's original posting and subsequent discussion on the AJKD Discussion Forum and on the NEPHROL E-mail discussion group. He argued that self-regulation was preferable to editorial decisions⁴. He emphasized the difficulty to determine the content of herbal preparations. The term CHN had never intended to denigrate the system of Chinese herbal medicine. Indeed, many useful compounds widely used in Western medicine came from Chinese herbal medicine.