Herbal remedies containing aristolochic acid and mushroom nephrotoxicity

Numerous myths have grown around medicinal herbs and their healing powers [1]. The myth of beneficent nature is resistant to the accumulated evidence of health problems resulting from unknown or underestimated toxicity as well as from adulteration and misidentification of medicinal herbs [2]. Many plants contain substances toxic to humans and therefore, not surprisingly, to the human kidney. In early 1993, a rapidly progressive kidney fail ure leading to end-stage renal disease was reported in a number of women who had ingested slimming pills that contained powdered Chinese herbs [3]. Further investigations showed that this so called “Chinese herb nephropathy” was, in fact, secondary to the replacement of one of the prescribed Chinese herb, Stephania tetrandra, by other mixtures of Chinese herbs containing Aristolochia Fang chi [4]. The term “Aristolochia nephropathy” was thus proposed to be used instead of “Chinese herb nephropathy (CHN)” [5]. Finally, due to the presence of aristolochic acids (AA) in Aristolochia spp. and to their further demonstrated nephrotoxicity (see below), the term of “Aristolochic acid nephropathy” (AAN) is now commonly used.