Overview of aristolochic acid nephropathy: an update

Abstract

Aristolochic acid nephropathy (AAN) is a rapidly progressive renal interstitial fibrosis caused by medical or environmental exposure to aristolochic acid (AA). Since the outbreak of AAN in Belgium was reported nearly 30 years ago, the safety of herbal remedies has drawn considerable attention, and AAN has become a global public health problem. Breakthroughs have been made to better understand the disease, including the toxicity of AAs, the possible mechanisms of AAN, the disease patterns, and the pathological features; however, some critical problems remain unresolved. Because of the insidious onset of the disease, the incidence of AAN and the prevalence of exposure to AAs are unknown and might be largely underestimated. During the past decades, AA-containing herbs have been strictly administrated in many regions and the occurrence of AAN has declined sharply, yet cases of AAN are still sporadically reported. Despite the progress in the understanding of the disease’s pathogenesis, there is no effective treatment for delaying or reversing the renal deterioration caused by AAN. Therefore, the risk of exposure to AAs should be taken seriously by public health workers and clinicians. In this review, we updated the latest data on AAN, summarized the advances throughout these years, and put forward some challenges for future research.

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“…AAI belongs to the aristolochic acids (AAs) family, characterized by nitrophenanthrene carboxylic acids commonly present in plants of the Aristolochiaceae family, with prominent occurrences in the Aristochia and Asarum genera (Figure 1A). 1,2 Herbal remedies and products frequently incorporate AAs to address colds, headaches, aphthous stomatitis, inflammatory conditions, snakebites, and sexual dysfunctions. 1,3 However, it is crucial to note that exposure to AAs constitutes a notable risk for severe nephropathy and a spectrum of malignancies such as urological and hepatobiliary cancers.…”

“…AAI belongs to the aristolochic acids (AAs) family, characterized by nitrophenanthrene carboxylic acids commonly present in plants of the Aristolochiaceae family, with prominent occurrences in the Aristochia and Asarum genera (Figure A). , Herbal remedies and products frequently incorporate AAs to address colds, headaches, aphthous stomatitis, inflammatory conditions, snakebites, and sexual dysfunctions. , However, it is crucial to note that exposure to AAs constitutes a notable risk for severe nephropathy and a spectrum of malignancies such as urological and hepatobiliary cancers. Research involving 67 Balkan patients with urinary tract tumors revealed that over two-thirds exhibited AA-DNA adducts in their renal cortex, with nearly half testing positive for the TP53 gene. , A study published in Science in 2017 pointed out that the widespread use of AA-containing traditional Chinese medicines is a major contributor to the incidence of liver cancer in Asia .…”