In 1964, Chinese scholar Songhan Wu first reported 2 patients with ARF caused by excessive application of Aristolochia manshuriensis. In 1993, Belgian scholars reported that 2 patients suffered from rapid progressive kidney disease due to continuous application of weight-loss drugs containing traditional Chinese medicine guangfangji, and thereafter, cases with similar or different phenotypes have been reported in many countries and regions, including China. Since then, a large number of studies have found that this kind of renal tubulointerstitial disease is due to the nephrotoxic and carcinogenic aristolochic acids (AA) contained in relevant traditional Chinese medicin and has been named aristolochic acid nephropathy (AAN). Medicinal or non medicinal plants containing aristolochic acids are widely distributed. Due to the hidden clinical onset, there is a lack of accurate prevalence in China. According to the national population CKD epidemiological survey in 2008, about 2.5% of ordinary residents in China have taken antipyretic analgesics and / or traditional Chinese medicine containing aristolochic acid for a long time or intermittently. If the cumulative dosage of aristolochic acid I (AA-I, the main toxic component) reaches more than 0.5g, the risk of CKD is more than 5 times that of those who have not taken it. More than 1000 cases have been reported in China. The pathogenesis of AAN. ①Direct toxicity: dose-dependent direct cytotoxicity to renal tubules; ② Inhibition of cell repair: AA-I can cause cell DNA damage and block the cell proliferation cycle (G2 / M phase block), thus inhibiting the repair ability of renal tubular epithelial cells. ③Chronic hypoxia, ischemic injury and interstitial fibrosis. In addition to causing AAN, AA also has carcinogenic effect, mainly leading to transitional epithelial carcinoma of urinary system. Its mechanism is considered to be related to the formation of AA DNA adduct. The main clinical manifestations are: ① Chronic AAN(more than 90%). Their characteristics are in line with the general characteristics of chronic interstitial nephritis, and most of them are chronic progressive renal failure. ② Acute AAN. Accounting for about 0~5%, it is often caused by continuous or excessive use of Chinese medicine decoction containing AA in a short time, with acute or subacute onset of renal failure. ③ Renal tubular dysfunction AAN. About 0 ~ 3% of the patients had intermittent medication and low dose, which showed varying degrees of renal tubular dysfunction or Fanconi syndrome. About 30% ~ 40% of patients with AAN can be accompanied by urinary transitional cell carcinoma. The renal pathology of AAN has certain characteristics. Immunopathological examination of renal tissue biopsy is usually negative. Light microscopic examination showed that severe tubular epithelial cell injury similar to acute tubular necrosis could be seen in some patients taking excessive drugs, including severe cell degeneration, necrosis or disintegration, and the formation of bare TBM. The lesions were often diffuse or multifocal, which was characterized by the lack of regeneration of tubular epithelial cells. Most patients with long-term intermittent medication often see varying degrees of renal tubular degeneration, cell abscission and bare TBM, usually obvious renal tubular atrophy, less inflammatory cell infiltration in renal interstitium, and prominent renal interstitial fibrosis. Renal pathological examination of some patients also showed ischemic shrinkage of glomerulus and decrease in the number of paratubular capillaries. In addition to the above-mentioned tubulointerstitial lesions, electron microscopic examination can also observe the swelling of renal interstitial microvascular endothelial organelles, stratification and even rupture of their basement membrane. There is no effective treatment for AAN. Its prognosis is poor, and the 2-year renal survival rate is only 17%, which is significantly lower than other types of tubulointerstitial nephropathy. About endemic tubulointerstitial nephropathy, Balkan nephropathy is generally believed as an endemic type of AAN, with a similar clinicopathologic features of chronic AAN. However, aetiology of CKD of unknown causes (CKDu) in Sri Lanka is still unknown.