Balkan endemic nephropathy

Balkan endemic nephropathy map

Balkan endemic nephropathy (BEN) is a chronic, progressive kidney disease that primarily affects rural populations in certain regions of the Balkans. It is characterized by a slow progression to end-stage renal disease (ESRD) and is often associated with upper urinary tract urothelial carcinoma.

Epidemiology

BEN is predominantly found in rural areas of Bosnia and Herzegovina, Bulgaria, Croatia, Romania, and Serbia. The disease has a familial clustering pattern, suggesting a possible genetic predisposition, although environmental factors are also believed to play a significant role.

Etiology

The exact cause of BEN remains unknown, but several hypotheses have been proposed. One of the leading theories is the exposure to aristolochic acid, a compound found in plants of the Aristolochiaceae family, which is believed to contaminate food supplies. Other potential factors include chronic exposure to mycotoxins, heavy metals, and other environmental toxins.

Pathophysiology

BEN is characterized by a slow, progressive loss of kidney function. Histologically, the kidneys of affected individuals show extensive interstitial fibrosis, tubular atrophy, and glomerulosclerosis. The disease often leads to end-stage renal disease (ESRD), requiring dialysis or kidney transplantation.

Clinical Features

Patients with BEN typically present with non-specific symptoms such as fatigue, loss of appetite, and weight loss. As the disease progresses, signs of chronic kidney disease (CKD) become more apparent, including hypertension, anemia, and uremia. The association with upper urinary tract urothelial carcinoma is a significant clinical feature, necessitating regular monitoring for malignancies.

Diagnosis

The diagnosis of BEN is primarily based on clinical and epidemiological criteria, including a history of residence in endemic areas, family history of the disease, and the presence of characteristic clinical and histopathological findings. Imaging studies and renal biopsy may be used to support the diagnosis.

Treatment

There is no specific treatment for BEN. Management focuses on slowing the progression of kidney disease and addressing complications. This includes controlling hypertension, managing anemia, and preparing for renal replacement therapy such as dialysis or kidney transplantation.

Prevention

Preventive measures are challenging due to the unclear etiology of BEN. Efforts are focused on reducing exposure to potential environmental toxins, improving food safety, and conducting regular health screenings in endemic areas.

Research

Ongoing research aims to better understand the etiology and pathogenesis of BEN, with the goal of developing targeted prevention and treatment strategies. Studies are also exploring the genetic factors that may contribute to the disease's familial clustering.

See also

• Chronic kidney disease
• End-stage renal disease
• Urothelial carcinoma
• Aristolochic acid