Aristolochic Acid Nephropathy: Molecular Mechanisms, Clinical Impact and Therapeutic Challenges in a Progressive Renal Disease

Aristolochic acid nephropathy (AAN) is a rapidly progressive form of interstitial nephritis associated with the use of medicinal plants from the Aristolochiaceae family, which contain aristolochic acid (AA) and environmental pollutants. It was first discovered in Belgium in the 1990s and is associated with progressive renal fibrosis and a high risk of urothelial carcinoma. Development and discussion: AAN is a toxic kidney disease associated with the consumption of medicinal plants with AA or contaminated food. It is characterized by progressive interstitial nephritis, renal fibrosis and an increased risk of urothelial carcinoma. Its pathogenesis includes mitochondrial DNA damage, TP53 mutations, inflammation and fibrosis. Clinically, the disease presents as progressive renal disease in chronic forms, acute renal damage after massive ingestion or mild tubular dysfunction. Diagnosis is based on the history of exposure, clinical findings, renal biopsy and urinary biomarkers. Complications include urothelial carcinoma, severe fibrosis and end-stage renal disease. Treatment requires elimination of AA exposure, oncologic surveillance, and advanced renal support. This emphasizes the need for targeted therapies to slow disease progression and improve prognosis. AAN is a multifactorial disease with severe renal impact and high oncologic morbidity. Prevention, early diagnosis and multidisciplinary management are crucial to improve the prognosis and quality of life of patients.