Aristolochic acid nephropathy: a worldwide problem.

Area of Science:

• Nephrology
• Toxicology
• Pharmacology

Background:

• Aristolochic acid nephropathy (AAN) is a progressive kidney fibrosis.
• It is frequently associated with urothelial malignancies.
• AAN was first reported in Belgian patients consuming slimming pills with Aristolochia fangchi.

Purpose of the Study:

• To highlight the global incidence and risk factors of Aristolochic acid nephropathy (AAN).
• To emphasize the risks associated with contaminated traditional medicines and food products.
• To underscore the ongoing public health threat posed by Aristolochic acid (AA)-containing herbs.

Main Methods:

• Review of reported AAN cases worldwide.
• Analysis of exposure routes including contaminated herbal medicines and food.
• Assessment of regulatory challenges and ongoing availability of AA-containing products.

Main Results:

• AAN cases are observed globally, with potentially high incidence in Asia and the Balkans.
• Traditional medicine use in Asia poses a risk due to botanical product substitution.
• Contaminated wheat flour in the Balkans may cause Balkan-endemic nephropathy.
• AA-containing herbs remain available online despite regulatory warnings.

Conclusions:

• Aristolochic acid (AA) exposure remains a significant global health concern.
• Increased vigilance and regulatory oversight are crucial to prevent AAN.
• Public awareness regarding the risks of contaminated botanical products is essential.