The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review

Ann Intern Med. 2013 Mar 19;158(6):469-77. doi: 10.7326/0003-4819-158-6-201303190-00006.


It has been 20 years since the first description of a rapidly progressive renal disease that is associated with the consumption of Chinese herbs containing aristolochic acid (AA) and is now termed aristolochic acid nephropathy (AAN). Recent data have shown that AA is also the primary causative agent in Balkan endemic nephropathy and associated urothelial cancer. Aristolochic acid nephropathy is associated with a high long-term risk for renal failure and urothelial cancer, and the potential worldwide population exposure is enormous. This evidence-based review of the diagnostic approach to and management of AAN draws on the authors' experience with the largest and longest-studied combined cohort of patients with this condition. It is hoped that a better understanding of the importance of this underrecognized and severe condition will improve epidemiologic, preventive, and therapeutic strategies to reduce the global burden of this disease.

Publication types

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

MeSH terms

  • Aristolochic Acids / adverse effects*
  • Balkan Nephropathy / chemically induced
  • Balkan Nephropathy / diagnosis
  • Balkan Nephropathy / epidemiology
  • Balkan Nephropathy / therapy
  • Humans
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy
  • Plant Preparations / adverse effects*
  • Risk Factors
  • Urologic Neoplasms / chemically induced
  • Urologic Neoplasms / diagnosis
  • Urologic Neoplasms / epidemiology
  • Urologic Neoplasms / physiopathology
  • Urologic Neoplasms / therapy


  • Aristolochic Acids
  • Plant Preparations
  • aristolochic acid I