Aristolochic acid is a naturally occurring toxic compound found in plants of the Aristolochia and Asarum species, which have been used in traditional herbal medicine for centuries. Chemically, it is a mixture mainly of aristolochic acid I and II, belonging to the group of nitrophenanthrene carboxylic acids. Although these plants were historically used for treating conditions such as arthritis, infections, and snake bites, aristolochic acid was later discovered to be highly nephrotoxic and carcinogenic. In the early 1990s, cases of rapidly progressive kidney failure in Belgium were linked to slimming pills containing Aristolochia extracts, leading to the identification of “aristolochic acid nephropathy.” Subsequent research confirmed its association with urothelial cancers due to DNA adduct formation and mutagenic effects. As a result, many countries have banned or strictly regulated products containing aristolochic acid, and it is now recognized as a potent human carcinogen.
