Aristolochic acid (AA), a plant compound used in herbal remedies since ancient times, is among the leading causes of kidney failure and upper urinary tract cancer (UUC).

In a study of 151 UUC patients in Taiwan, Arthur Grollman, professor of pharmacological sciences, Stony Brook University School of Medicine, and a team of scientists, concluded that exposure to AA is a primary contributor to UUC in Taiwan, where its incidence is stated to be the highest in the world.

This finding holds broad implications for global public health, as individuals treated with herbal preparations available worldwide that contain Aristolochia are at significant risk of developing chronic kidney disease or UUC, the journal Proceedings of the National Academy of Science reports.

"We believe our latest research highlights the importance of a long-overlooked disease that affects many individuals in Taiwan, and, by extension, in China and other countries worldwide, where Aristolochia herbal remedies traditionally have been used for medicinal purposes," says Grollman.

Aristolochic acid is recognized by the US health department as a powerful nephrotoxin and human carcinogen linked with chronic kidney disease and UUC, according to a Stony Brook statement.

The dual toxicities and target tissues were originally revealed when a group of healthy Belgian women developed renal failure and UUC after ingesting Aristolochia herbs to lose weight. Other cases of aristolochic acid nephropathy (AAN) and UUC were subsequently reported worldwide.

Most recently, Grollman and colleagues proved AA to be the causative agent of endemic nephropathy in the Balkans, solving a 50-year-old medical mystery that pointed to the ingestion of Aristolochia clematitis, or birthwort, contained in wheat.

Using their previous work in the Balkans as a guide, Grollman and colleagues looked toward other areas where Aristolochia might be consumed and in which there was a high incidence of kidney disease and UUC. Taiwan appeared to demonstrate exactly that connection.