Update of aristolochic acid nephropathy in Korea

Abstract

Background/AimsThe true incidence of aristolochic acid nephropathy (AAN) is thought to be underestimated because numerous ingredients known or suspected to contain aristolochic acid (AA) are used in traditional medicine in Korea.MethodsWe collected data on cases of AAN since 1996 via a database in Korea. We evaluated the year of AAN development, route to obtaining AA-containing herbal medicine, gender, reason for taking AA-containing herbal medicine, clinical manifestations, histological findings, phytochemical analysis, and prognosis of patients with AAN.ResultsData on 16 cases of AAN were collected. Thirteen cases developed AAN before and three cases after the prohibition of AA-containing herbal medicine by the Korea Food and Drug Administration. Patients were prescribed AA-containing herbal medicine from oriental clinics or had purchased it from traditional markets. AAN was distributed in all age groups. Young females were most commonly exposed to AA-containing herbal medicine for slimming purposes and postpartum health promotion, while older adults took AA-containing compounds for the treatment of chronic diseases. The most common symptoms presented at hospitalization were nausea and vomiting, and acute kidney injury was accompanied by Fanconi syndrome in almost half of the patients. Phytochemical analysis of AA in herbal medicine was available in six cases. Progression to end stage renal disease (ESRD) was observed in seven patients (43.8%), and five patients (31.3%) had progressed to ESRD within 6 months of diagnosis.ConclusionsOur report shows that patients were still exposed to AA-containing herbal medicine and that there is a possibility of underdiagnosis of AAN in Korea. A stronger national supervision system of herbal ingredients and remedies in oriental medicine is needed to prevent AAN.

Integration of medicinal plants into the traditional system of medicine for the treatment of cancer in Sokoto State, Nigeria

“…Generally, Aristolochia and one of its chief components aristolochic acid have been known for its carcinogenic, and nephrotoxic effects for a very long time ( Michael et al., 2009 ). Recently, several toxicological risks associated with a history of using herbal medicines containing aristolochic acid amongst cancer patients have been reported ( Aydin et al., 2017 ; Ban et al., 2018 ; Chen et al., 2018 ; Hoang et al., 2016 ; Hung et al., 2016 ; Kanaan et al., 2016 ; Popovska-Jankovic et al., 2016 ; Xiong et al., 2018 ; Zhong et al., 2017 ). Despite the reported cases on the use of herbs containing aristolochic acid around the world, a similar effect associated with the use of Aristolochia spp has yet to be reported in Nigeria.…”

Co-Exposure to Aristolochic Acids I and II Increases DNA Adduct Formation Responsible for Aristolochic Acid I-Mediated Carcinogenicity in Rats

“…It is responsible for two serious renal diseases, AAN and BEN, both of which are associated with the development of upper urothelial cancer [ 9 , 10 , 11 , 12 , 13 , 15 , 16 , 17 ]. Despite the known carcinogenic properties of AA [ 2 , 3 , 4 , 5 , 6 , 7 ], Aristolochiaceae species are still used in traditional herbal medicine, particularly in Asia, where potentially millions of people are exposed to the nephrotoxic and carcinogenic effects of AA [ 11 , 39 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. While AAI, the major component of the plant extract, has been identified as a crucial factor for the development of UUC by inducing specific A:T→T:A transversion mutations in the DNA of patients suffering from AAN and BEN [ 4 , 13 , 38 , 40 , 42 ], the effects of the second major component, AAII, remain to better understood.…”

Systematic Overview of Aristolochic Acids: Nephrotoxicity, Carcinogenicity, and Underlying Mechanisms

“…Long-term ingestion of herbal formula known or suspected to contain AAs is one of the prominent risk factors for developing AAN (Jia et al, 2005; Vervaet et al, 2017). Although the sale and use of AA-containing products are banned or restricted in most of the countries (Krell and Stebbing, 2013), AAN induced by numerous herbal remedies and products are still reported from all over the world (Lord et al, 1999; Yang et al, 2006; Debelle et al, 2008; Shaohua et al, 2010; Wu et al, 2012; Vaclavik et al, 2014; Ban et al, 2018).…”