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Aristolochic acid nephropathy

Research in Bangladesh reveals that more awareness needs to be raised about the health risks of using Aristolochia as a herbal medicine.
Photo of a herbal medicine shop in Old Dhaka, Bangladesh
Herbal medicine shop in Old Dhaka, Bangladesh (Photo: F. Michl)

Use of Aristolochia in herbal medicines has been associated with kidney damage (aristolochic acid nephropathy or AAN) in several countries but its true incidence is unknown, for example, in the Indian subcontinent. PhD student Johanna Michl (University College London/Kew) has combined ethnobotanical and phytochemical surveys to provide evidence for the risk of AAN occurring in Bangladesh.

Interviews with traditional healers revealed Aristolochia indica is commonly used for symptoms such as snake bite and sexual problems, often in high doses. Phytochemical analysis at Kew showed the presence of a variety of aristolochic acids in most samples, and for some it revealed that Aristolochia had been replaced by other medicinal plants such as Rauvolfia. Cases of AAN are therefore likely to occur in Bangladesh, and more awareness needs to be raised about the health risks associated with the use of Aristolochia as a herbal medicine.

In a complementary study, the toxicity of naturally-occurring aristolochic acid analogues has been reviewed.


Michl, J., Jennings, H.M., Kite, G.C., Ingrouille, M.J., Simmonds, M.S.J. & Heinrich, M. (2013). Is aristolochic acid nephropathy a widespread problem in developing countries? A case study of Aristolochia indica L. in Bangladesh using an ethnobotanical-phytochemical approach. Journal of Ethnopharmacology 149: 235–244. Available online

Michl, J., Ingrouille,M.J., Simmonds, M.S.J. & Heinrich, M. (2014). Naturally occurring aristolochic acid analogues and their toxicities. Natural Product Reports 31: 676–693. Available online

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