Nefropatía inducida por Ácido Aristolóquico.

Abstract

Introduction: Aristolochic acids contain a carboxylic nitro phenanthrene group and can be found in medicinal herbs of the genus Aristolochia. Their nephrotoxicity has been confirmed in endemic geographic areas such as the Balkans of Europe and the Central American region. The clinical findings consist of tubulointerstitial nephropathy and generally go unnoticed until the advanced stages of chronic kidney disease. Objective of the review: The aim is to describe the main pathophysiological aspects and establish diagnostic and treatment criteria in patients with Aristolochic Acid Nephropathy. Essential points of the review: About 180 types of aristolochic acids (AAs) have been discovered, the most critical types AAΙ, AAΙΙ, AAΙΙΙa (AA C) and AAΙVa (AA D), which are differentiated according to the position of their hydroxyl radical (OH), hydrogen (H) and methoxyl (OCH3). AA-induced nephropathy occurs through at least five pathways that associate the depletion of intracellular glutathione, cellular damage due to induction of cell apoptosis, direct damage to the endoplasmic reticulum, and mitochondrial damage. This produces atrophic tubular injury and interstitial fibrosis; the metabolite has a bladder neoplastic effect. Conclusion: The incidence of aristolochic acid nephropathy is probably much higher than initially thought, and its existence should be considered in patients who present with chronic kidney disease with a tubulo-interstitial clinical pattern.