Aristolochic acid nephropathy: a worldwide problem

Kidney Int. 2008 Jul;74(2):158-69. doi: 10.1038/ki.2008.129. Epub 2008 Apr 16.


Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies, was initially reported in a Belgian cohort of more than 100 patients after the intake of slimming pills containing a Chinese herb, Aristolochia fangchi. Although botanicals known or suspected to contain aristolochic acid (AA) were no longer permitted in many countries, several AAN cases were regularly observed all around the world. The incidence of AAN is probably much higher than initially thought, especially in Asia and the Balkans. In Asian countries, where traditional medicines are very popular, the complexity of the pharmacopoeia represents a high risk for AAN because of the frequent substitution of the botanical products by AA-containing herbs. In the Balkan regions, the exposure to AA found in flour obtained from wheat contaminated with seeds of Aristolochia clematitis could be responsible for the so-called Balkan-endemic nephropathy. Finally, despite the Food and Drug Administration's warnings concerning the safety of botanical remedies containing AA, these herbs are still sold via the Internet.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Aristolochia / adverse effects*
  • Aristolochia / toxicity
  • Aristolochic Acids / adverse effects*
  • Aristolochic Acids / metabolism
  • Aristolochic Acids / toxicity
  • Balkan Nephropathy / chemically induced
  • Balkan Nephropathy / epidemiology
  • Balkan Nephropathy / metabolism
  • Belgium / epidemiology
  • Cell Transformation, Neoplastic / chemically induced
  • DNA Adducts / biosynthesis
  • Disease Outbreaks
  • Drugs, Chinese Herbal / adverse effects*
  • Drugs, Chinese Herbal / toxicity
  • Female
  • Global Health
  • Humans
  • Incidence
  • Kidney Neoplasms / chemically induced
  • Kidney Neoplasms / epidemiology
  • Kidney Neoplasms / metabolism
  • Nephritis, Interstitial / chemically induced*
  • Nephritis, Interstitial / epidemiology*
  • Nephritis, Interstitial / metabolism


  • Aristolochic Acids
  • DNA Adducts
  • Drugs, Chinese Herbal
  • aristolochic acid I