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Aristolochic Acid Nephropathy: Epidemiology, Clinical Presentation, and Treatment

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Abstract

Aristolochic acid (AA) is a compound extracted from the Aristolochia species of herbs. It has been used for centuries as a remedy for various illnesses and diseases. However, in the early 1990s in the setting of a weight loss herbal remedy, AA exposure was associated with a syndrome of kidney injury, termed aristolochic acid nephropathy (AAN). This entity is marked by elevated serum creatinine, significant anemia, and histopathologic changes demonstrating a hypocellular interstitial infiltrate with severe fibrosis. Progression towards end-stage renal disease (ESRD) is rapid, with most patients having chronic kidney disease for less than 2 years. In addition, AAN is associated with a 40–45 % prevalence of urothelial carcinomas. Treatment of AAN is limited to glucocorticoids that have been shown to delay progression in non-randomized trials. As most patients progress to ESRD, need for renal replacement therapy, as either dialysis or kidney transplant, usually ensues. However, given the high malignant potential, care must be taken to minimize future development of upper urinary tract cancers by performing prophylactic bilateral nephroureterectomies and aggressive cancer surveillance.

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Conflict of interest

No sources of funding were used to assist in the preparation of this study. Randy L. Luciano and Mark A. Perazella have no conflicts of interest that are directly relevant to the content of this study.

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  1. Section of Nephrology, Yale University School of Medicine, 330 Cedar Street, Boardman 114, New Haven, CT, 06510, USA

    Randy L. Luciano & Mark A. Perazella

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Luciano, R.L., Perazella, M.A. Aristolochic Acid Nephropathy: Epidemiology, Clinical Presentation, and Treatment. Drug Saf 38, 55–64 (2015). https://doi.org/10.1007/s40264-014-0244-x

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