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Aristolochic Acid Nephropathy and Balkan Nephropathy

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Tubulointerstitial Nephritis

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Abstract

Aristolochic acids are contained in plants of Aristolochia species. Aristolochic acid nephropathy (AAN) is a global term including any form of toxic interstitial nephropathy that is caused either by the ingestion of plants containing aristolochic acids (AA) as part of traditional phytotherapies or by environmental contaminants in food. It is characterized by a progressive interstitial fibrosis and frequently associated with urinary tract cancer (upper tract and/or bladder).

Originally, AAN was reported in Belgium after the intake of slimming pills containing powdered root extracts of a Chinese herb, Aristolochia fangchi. It is now estimated that exposure to AA affects thousands of individuals worldwide, particularly in Asian countries and in the Balkans. The aetiology of the so-called Balkan nephropathy has been revisited and is now associated with the chronic ingestion of AA from the contamination of wheat fields of the rural endemic regions by seeds of Aristolochia clematitis.

Experimental models of AAN confirmed the causal link between AA exposure and the onset of acute and chronic nephrotoxicity, as well as urothelial malignancies.

Any unusual observation of kidney failure and/or urothelial cancer should lead to a questioning about any prior exposure to AA. As the ingestion of AA containing compounds is not easily assessed, kidney biopsy remains crucial by demonstrating typically histopathological patterns. Moreover, aristolactam-DNA adducts and a specific mutational signature (A:T to T:A transversion) in the TP53 tumor suppressor gene may serve as biomarkers of exposure to AA. Finally, considering the highly carcinogenic properties of AA, a systematic endo-urological screening is absolutely necessary.

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Authors and Affiliations

  1. Department of Nephrology-Dialysis, Brugmann University Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium

    Joëlle L. Nortier

  2. Laboratory of Experimental Nephrology, Faculty of Medicine, Université libre de Bruxelles (ULB), Brussels, Belgium

    Joëlle L. Nortier

  3. Department of Nephrology, Erasme University Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium

    Jean-Louis Vanherweghem

  4. Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia

    Bojan Jelakovic

  5. School of Medicine, University of Zagreb, Zagreb, Croatia

    Bojan Jelakovic

Authors
  1. Joëlle L. Nortier
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  2. Jean-Louis Vanherweghem
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  3. Bojan Jelakovic
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Correspondence to Joëlle L. Nortier .

Editor information

Editors and Affiliations

  1. Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA

    Mohamed G. Atta

  2. Section of Nephrology, Department of Internal Medicine, Yale University, New Haven, CT, USA

    Mark A. Perazella

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Nortier, J.L., Vanherweghem, JL., Jelakovic, B. (2022). Aristolochic Acid Nephropathy and Balkan Nephropathy. In: Atta, M.G., Perazella, M.A. (eds) Tubulointerstitial Nephritis. Springer, Cham. https://doi.org/10.1007/978-3-030-93438-5_16

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  • DOI: https://doi.org/10.1007/978-3-030-93438-5_16

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