Aristolochic Acid-Induced Chronic Kidney Disease

Aristolochic Acid Nephropathy was originally termed Balkan Endemic Nephropathy. It is also an illness that is officially described as a 'Chronic Kidney Disease of non-Traditional causes (CKDnT)'.

The condition was first identified in the 1920s among several small rural communities along the Danube River and its major tributaries, now flowing in countries such as Croatia, Bosnia and Herzegovina, Serbia, Romania and Bulgaria[1].

Patients with this CKDnT do not have the commonly known risk factors for kidney disease, such as diabetes or hypertension. Which means that another etiology must have been at work here. This type of CKDnT 'only' affected adults, thus no children reported as having this affliction.

Over the last 50 years, several hypotheses on the cause of Balkan Endemic Nephropathy had been formulated, including mycotoxins, heavy metals, viruses and trace-element insufficiencies[2]. However, recent studies provide evidence that chronic dietary exposure to aristolochic acid, the principal component of the (European) birthwort (Aristolochia clematitis), which grows as a weed in the wheat fields of the endemic regions, is the cause of Balkan Endemic Nephropathy.

[Possible subdivisions of Aristolochic Acid Nephropathy]

Dietary exposure isn't confined to grain that is contaminated with birthwort, but the plant (or its close relative) is also widely used in herbal remedies and slimming pills[3]. Well, you certainly lose weight quite rapidly if your kidneys fail. As a result, this rapidly progressive renal disease has since been renamed to Aristolochic Acid Nephropathy.

There is no specific treatment, so therapy is largely supportive, aiming to delay disease progression.

I propose to call this Chronic Kidney Disease of non-Traditional causes Aristologic Acid- Induced Chronic Kidney Disease.  

[1] Chernozemsky et al: Geographic correlation between the occurrence of endemic nephropathy and urinary tract tumours in Vratza district, Bulgaria in International Journal of Cancer – 1977
[2] Stiborová et al: Balkan endemic nephropathy: an update on its aetiology in Archives of Toxicology – 2016
[3] Gökmen et al: The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review in Annals of Internal Medicine – 2013