[Influence of taking aristolochic acid-containing Chinese drugs on occurrence of urinary transitional cell cancer in uremic uremic patients undergoing dialysis].

OBJECTIVE

To investigate the prevalence and clinical characteristics of urinary transitional cell cancer (TCC) in uremic patients undergoing dialysis who have history of taking aristolochic acid (AA)-containing Chinese drugs.

METHODS

A questionnaire survey was conducted among 283 uremic patients with history of taking aristolochic acid (AA)-containing Chinese drug who were undergoing dialysis, 118 males and 165 females, aged 59 +/- 13 (22-88), to understand the drug-taking history, nephropathy-related situation, and prevalence and clinic TCC pathological features of TCC.

RESULTS

Twenty-four of the 283 were suffering concomitant TCC with a prevalence rate of 8.48%. Sixty-six of the 283 patients had a history of taking AA-containing Chinese drugs, 22 of which had developed TCC with a prevalence rate of 33.3%, significantly higher than that among the 198 patients without a history of taking AA-containing Chinese drugs (1.0%, P < 0.01). Seventeen (94.4%) of the 18 TCC patients with a clear AA-taking history reported took the drug at routine doses for a long time, and 1 of the 18 patients took overdose of AA-containing drug. The average time between the beginning of taking AA-containing drugs and the occurrence of TCC was 10 years. TCC was found only in the patients with remnant urine > 100 ml after dialysis (8/38, 21.0%) and was not found in those with anuria after dialysis. The first symptom in the 18 TCC cases was intermittent painless hematuria. The positive rates of imageology and nuclear matrix protein (NMP)-22 detection were both more than 90%. Tumor was found in the urinary bladder or ureter (11/18, 61.2%). The relapse rate after routine surgery was 27.8%.

CONCLUSIONS

With a very high prevalence of TCC, the patients with a history of taking AA-containing Chinese drugs should be monitored closely.