STONY BROOK, N.Y.—Aristolochic acid, a component of a plant used in herbal remedies since ancient times and still used in certain herbal medicines worldwide, leads to kidney failure and upper urinary tract cancer in individuals exposed to the toxin.
Balkan endemic nephropathy, a disease limited to rural areas in the Danube river basin, is characterized by progressive kidney failure, frequently coupled with the development of urothelial cell carcinomas (UUC). Aristolochia clematitis, known popularly as “birthwort” often grows along with wheat in local wheat fields.
This association is reported by Arthur Grollman, MD, Distinguished Professor of Pharmacological Sciences, Stony Brook University School of Medicine, and an international team of scientists, based on their study of patients in Croatia, Bosnia and Serbia with the unusual kidney disease known as Balkan endemic nephropathy. Their findings, an explanation of the 50-year-old mystery as to the cause of these devastating diseases, are reported in the early online edition of Kidney International.
Six years ago, Dr. Grollman and his colleagues initiated studies based on the hypothesis that exposure to the toxin in endemic areas was the result of ingestion of contaminated wheat grain.
“Results of our study indicate that dietary exposure to aristolochic acid in this population is causally related to endemic nephropathy and carcinomas of the upper urinary tract in genetically susceptible individuals,” said Dr. Grollman.
“Implications of these results go beyond the population of those exposed in the Balkans, as millions of people worldwide are at risk for developing diseases due to aristolochic acid exposure from traditional remedies prepared from Aristolochia herbs. More broadly, we believe that aristolochic acid nephropathy and urothelial cell carcinoma represent a long-overlooked global disease and an international public health problem of significant magnitude.”
