Endemic Nephropathy: the Case for Chronic Poisoning by Aristolochia

Hranjec, Tjaša; Kovač, Anamarija; Kos, Jelena; Wenyang Mao; Chen, John J.; Grollman, Arthur P.; Jelaković, Bojan
February 2005
Croatian Medical Journal;2005, Vol. 46 Issue 1, p116
Academic Journal
Aim: To explore the hypothesis that chronic dietary poisoning by aristolochic acid could account for the unique geographical distribution, specific pattern of tubulointerstitial fibrosis, occurrence of chronic renal insufficiency, and an increased risk of developing upper urothelial cancer, all of which are associated with endemic nephropathy. Methods: This case-controlled epidemiologic study consisted of three groups of subjects residing in an endemic region of Croatia: (a) patients meeting WHO criteria for endemic nephropathy (n=28), (b) individuals who have been treated for renal insufficiency secondary to other forms of renal disease (n=30), and (c) apparently healthy residents of the endemic village (n=30). A detailed questionnaire,designed to collect information on demographics, exposure to potentially toxic substances, diet, agricultural practices, and other factors potentially impacting endemic nephropathy was administered to the three study groups. The seeds of Aristolochia clematitis obtained from plants growing in the endemic region, were extracted with ethanol and analyzed by high-performance liquid chromatography for their aristolochic acid content. Results: The majority of subjects, including 90% of endemic nephropathy patients, recall that the plant Aristolochia clematitis (birthwort, vučja stopa in Croatian) was frequently found in local meadows and wheat fields between 20 and 30 years ago. At that time, endemic nephropathy patients encountered Aristolochia clematitis significantly more frequently than controls (P=0.035). Since then, all three study groups reported a significant increase in the use of herbicides (P<0.001) and reduction in the prevalence of Aristolochia clematitis (P<0.001). Chemical analysis established that the seeds of A. clematitis contain 0.65% aristolochic acid. It is likely that the harvesting process used by local farmers permitted the seeds of A. clematitis to mingle with the wheat grain. Conclusion: Flour us...


Related Articles

  • Nature of the Virus Associated with Endemic Balkan Nephropathy. Riquelme, Cristina; Escors, David; Ortego, Javier; Sanchez, Carlos M.; Uzelac-Keserovic, Branislava; Apostolov, Konstantin; Enjuanes, Luis // Emerging Infectious Diseases;Aug2002, Vol. 8 Issue 8, p869 

    Deals with a study which clarified whether the endemic Balkan nephropathy-associated virus is related to members of the Coronaviridae family. Method; Results; Discussion.

  • Population-genetic study of Balkan endemic nephropathy in Serbia. Marinkovic, D.; Cvjeticanin, S. // Russian Journal of Genetics;Aug2007, Vol. 43 Issue 8, p942 

    The study of Balkan endemic nephropathy (BEN) in the affected localities of southern Serbia shows population-genetic difference between samples of BEN affected individuals and control group consisting of non-affected individuals from the same localities. Detailed population-genetic study in...

  • Association of angiotensin-converting enzyme and endothelial Nitric Oxide synthase gene polymorphisms with vascular disease in ESRD patients in a Chinese population. Feng-Ying Tang; Fu-You Liu; Xiong-Wei Xie // Molecular & Cellular Biochemistry;Dec2008, Vol. 319 Issue 1/2, p33 

    Abstract   Background The effect of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and endothelial Nitric Oxide synthase (eNOS) gene G894 → T on vascular disease in end-stage renal disease (ESRD) patients was rarely studied previously. We...

  • The prevention of contrast induced nephropathy by sarpogrelate in patients with chronic kidney disease: a study protocol for a prospective randomized controlled clinical trial. Kyungil Park; Woo-Young Chung; Jae-Bin Seo; Sang-Hyun Kim; Joo-Hee Zo; Kim, Myung-A.; Young-Bae Park // Trials;2010, Vol. 11, p122 

    Background: Contrast-induced nephropathy (CIN) is a serious clinical problem associated with increased morbidity and mortality, particularly in patients with chronic renal insufficiency. Although some agents including hydration with saline are being prescribed to prevent renal deterioration in...

  • Aristolochia and renal failure.  // WHO Drug Information;1999, Vol. 13 Issue 3, p174 

    Reports on the adverse reactions associated with the use of Chinese herbal medicines containing Aristolochia in Great Britain. Two reports received of patients with renal end-stage renal failure; Medicines Control Agency's sampling and testing of Chinese herbal medicines.

  • Tubular marker excretion in children from families with Balkan nephropathy. Stefanovic, Vladisav; Cukuranovic, Rade; Djordjevic, Vidosava; Jovanovic, Ivan; Lecic, Nevenka; Rajic, Milena // Pediatric Nephrology;Nov2009, Vol. 24 Issue 11, p2155 

    Balkan nephropathy (BN) has not been described in children; however, some previous studies in children from families with BN have revealed abnormalities of the urinary tract. In this study, urinary excretion of β2-microglobulin, N-acetyl-β-D-glucosaminidase (NAG) and gamma-glutamyl...

  • Chinese herbs nephropathy: A clue to Balkan endemic nephropathy? Cosyns, Jean-Pierre; Jadoul, Michel; Squifflet, Jean-Paul; De Plaen, Jean-Françoise; Ferluga, Dusan; van Ypersele de Strihou, Charles // Kidney International;Jun1994, Vol. 45 Issue 6, p1680 

    Rapidly progressive interstitial renal fibrosis has recently been reported in young women who have been on a slimming regimen including Chinese herbs. We examined four nephroureterectomies performed in three patients prior to or at the time of transplantation to determine the nature and...

  • Anthropological Aspect of Death in Dialyzed Patients. Novaković, Milan; Babić, Dragan; Milovanović, Aleksandar; Tiosavljević-Marić, Danijela; Novaković, Radmila; Novaković, Mitar // Collegium Antropologicum;Jun2008, Vol. 32 Issue 2, p587 

    The aim of this article is to compare the incidence of thanatophobia in dialysed patients having Balkan endemic nephropathy IBEN) with a control group (N18) members where some of them have chronic renal failure (CRF), but not (BEN). We examined thanatophobia on a sample of 753 dialysed patients...

  • Diabetes and chronic kidney disease. Hall, Gwen // Practice Nurse;3/27/2009, Vol. 37 Issue 6, p32 

    The article presents an overview of the relationship which exists between type 2 diabetes and the development of chronic kidney disease. A discussion of guidelines which have been developed by Great Britain's Department of Health and which focus on renal investigations for people with diabetes...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics