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Aristolochic Acid and Kidney Injury: A Documented Herbal Harm

How aristolochic acid in some herbal products caused kidney failure and urinary tract cancer, what regulators have done, and why herb substitution matters.

Content last updated . This page has not been medically reviewed.

Urgent first

Reduced urination, swelling, severe tiredness, vomiting or blood in the urine after taking a herbal product need prompt medical care; collapse needs emergency care (US: 911). Poison Help in the US: 1-800-222-1222. If you took a product that may contain aristolochic acid in the past, tell your doctor, who can decide whether any follow-up is needed.

What aristolochic acid is

Aristolochic acid (AA) is a compound found in plants of the Aristolochia group. A review describes aristolochic acid nephropathy as a rapidly progressive scarring of the kidney's interstitial tissue caused by medical or environmental exposure to AA. [1] AA exposure is also associated with a high incidence of urothelial (urinary tract lining) cancer, and there is no effective treatment for delaying or reversing the kidney deterioration. [1]

How it happened: the Belgian slimming pills

In the early 1990s in Belgium, young women taking slimming pills developed rapidly progressive kidney disease. Roots of Stephania tetrandra (Han Fang Ji) had been mistakenly replaced with roots of an AA-containing herb (Guang Fang Ji, Aristolochia fangchi). [1] The names are similar and both are "Fang Ji" in TCM. This is a documented case of product error, not proof that the original herb was harmful.

Taiwan

A narrative review reports that a nationwide database showed 39% of the Taiwanese population had been exposed to AA-containing herbs between 1997 and 2003, and that AA is a principal cause of the high incidence of upper urinary tract urothelial cancer there. [2] The review states that, apart from prophylactic nephrectomy, there are no preventive measures for people at risk. [2] A cohort of 38,995 people with end-stage kidney disease in Taiwan found that having been prescribed Mu Tong adulterated with Guan Mu Tong (Aristolochia manshuriensis) before 2004 was associated with increased urothelial cancer risk. [3] These are observational studies, so they show association rather than proof for each individual.

Frequently asked questions

Is aristolochic acid banned?

Many countries have banned or restricted AA-containing products; the US FDA issued an alert in 2001 and has an import alert. [1][4]

Can the kidney damage be reversed?

A review states there is no effective treatment for delaying or reversing the kidney damage from AA nephropathy. [1]

Does AA cause cancer?

Exposure is associated with a high incidence of urothelial cancer. [1][2]

Is every Chinese herb with "Fang Ji" or "Mu Tong" in its name dangerous?

No. The Belgian case involved a mix-up between look-alike herbs. The risk comes from the AA-containing one. [1]

Can I check my own herbs for AA?

No source we read describes a home check. Ask your practitioner about identity checks and see your doctor if worried.

More details: evidence, limits and cautions

The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.

What regulators have said
The US FDA issued an alert in 2001, and many countries have banned or restricted products with AA. [1] An FDA import alert (published 2020) describes AA as a "potent carcinogen and nephrotoxin", covers dietary supplements or drugs labeled as containing Aristolochia species, and attributes several outbreaks of renal failure to Chinese herbal medicines in which the listed plant ingredient was mis-identified. [4] A review says occasional cases still occur. [1] We did not read other national regulators' notices this session.
How to lower your risk
  • Do not buy products of unknown origin or with no ingredient list. See Buying Chinese Herbs Safely.
  • Ask a practitioner whether any herb in your formula belongs to the Aristolochia or "Fang Ji", "Mu Tong" or similar groups, and how the supplier confirms identity. This is a question for them, not a self-identification task.
  • Tell your doctor of any past use if you have unexplained kidney problems.
  • If you have kidney disease, check with your kidney doctor before any herbal product; the NHS advises against herbal medicines with kidney problems. [5]

More on look-alike substitution is on Adulteration and Substitution and Chinese Herbs With Known Safety Concerns.

Evidence label: evidence of harm (well documented).

References
  1. Zhou Q, Jiang L, Su T, Liu G, Yang L. Overview of aristolochic acid nephropathy: an update. Kidney Res Clin Pract. 2023;42(5):579-590. Read 2026-10-22.
  2. Dickman KG, Chen CH, Grollman AP, Pu YS. Aristolochic acid-containing Chinese herbal medicine and upper urinary tract urothelial carcinoma in Taiwan: a narrative review. World J Urol. 2023;41(4):899-907. Read 2026-10-22.
  3. Wang SM, Lai MN, Wei A, et al. Increased risk of urinary tract cancer in ESRD patients associated with usage of Chinese herbal products suspected of containing aristolochic acid. PLoS One. 2014;9(8):e105218. Read 2026-10-22.
  4. US Food and Drug Administration. Import Alert 54-10 (aristolochic acid). Published 12/10/2020; charge statement revised 04/23/2019. Read 2026-10-22.
  5. NHS (UK). Herbal medicines and complementary therapies. Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.