Invasive urothelial carcinoma after exposure to Chinese herbal medicine containing aristolochic acid may occur without severe renal failure.

Chinese-herb nephropathy (CHN) was initially reported as a progressive renal interstitial fibrosis caused by the regular intake of Chinese herbal medicine belonging to the Aristolochia species containing nephrotoxic and carcinogenic aristolochic acid (AA) [1–3]. Prior exposure to AA was attested by the detection of specific DNA adducts formed by AA metabolites in kidneys and ureters of patients suffering from end-stage renal disease (ESRD) due to CHN [4–6]. Among these patients, a high prevalence of upper urinary tract carcinoma was observed [5,7]. Up to now, urothelial cancer seems to be a late complication of CHN since all the cases have been detected in patients with ESRD. We report here a case of Aristolochia-related urinary tract cancer without significant renal failure, suggesting dissociation between carcinogenicity and nephrotoxicity of AA.