Early detection of Balkan endemic nephropathy in Bosanska Posavina.

Enisa Mešić

doi:10.17305/bjbms.2010.2655

Abstract

Balkan endemic nephropathy (BEN) is a chronic tubulointersticial nephropathy that is diagnosed in a few agrarian regions of Balkan. Even tough numerous dilemmas and conflicting opinions regarding BEN etiology are encountered in literature, prevailing theory is that BEN is caused by chronic poisoning with aristolochic acid ingested by food in people with genetic predisposition to this disease. BEN is categorized as a toxic tubulointerstitial nephropathy, with clinical picture and disease progression not differing from other tubulointerstitial nephropathies, but with insidious and gradual progression to end stage renal disease. There is no specific and sensitive diagnostic biomarkers for BEN and we use epidemiological and functional diagnostic criteria. It is considered that BEN affects up to 10% of population in endemic region. According to Renal Register of Bosnia and Herzegovina, there are around 15% of BEN patients on chronic dialysis program, but no official data on the number of predialysis BEN patients, because of lack of adequate demographic data and screening or systematic examinations of the population living in the affected region since 1991. The members of the Society of nephrology, dialysis and transplantation of Bosnia and Herzegovina organized screening in two villages of Bosanska Posavina, as a part of the "Program Program of detection of chronic kidney diseases in high-risk population in Bosnia and Herzegovina", project which was approved from International Society of nephrology. In this paper we analyze preliminary results of that Program and discuss previous studies about BEN in Bosnia and Herzegovina, particularly diagnostic criteria and biomarkers of BEN.

Highlights

Balkan endemic nephropathy (BEN) is a chronic irreversible tubulointersticial nephritis still of unknown etiology that is diagnosed in a few agrarian regions of Balkan (Bosnia and Herzegovina, Bulgaria, Croatia, Romania, Serbia)
There were no significant changes in the geographic characteristics of BEN distribution since the first disease descriptions in tees of twentieth century ( ). e villages that were affected with the disease in the past are still endemic BEN regions, while nonendemic villages, sometimes located in close proximity to them, still have no cases of the disease registered
Basic screening for BEN assumes getting answers for questions: weather subject lives in an endemic village for more than years, weather the subject lives in the affected household for more than year, is there a proximal tubular proteinuria (α MG), decreased renal function, urothelial carcinoma, and if subject is treated for any other disease that could cause chronic renal disease

Summary

Introduction

Balkan endemic nephropathy (BEN) is a chronic irreversible tubulointersticial nephritis still of unknown etiology that is diagnosed in a few agrarian regions of Balkan (Bosnia and Herzegovina, Bulgaria, Croatia, Romania, Serbia). Basic criteria for diagnosis of BEN were according to Danilovic ( ): working in agriculture in affected regions, positive family history of renal disease, proteinuria (low grade, usually intermittent), low specific gravity of urine, anemia and high blood urea nitrogen.

Results

Conclusion