Endemic Balkan Nephropathy

Endemic Balkan nephropathy is a chronic non-inflammatory lesion of renal tubulointerstitium.

[1], [2]

Epidemiology

Endemic Balkan Nephropathy is observed only in the Danube basin in Serbia, Romania, Bosnia and Herzegovina, Croatia and Bulgaria. Endemic Balkan nephropathy is of a family nature.

[3], [4], [5], [6], [7],

Causes of the endemic Balkan Nephropathy

The causes and risk factors for endemic Balkan nephropathy have not been established. All the sick, as a rule, work in the field of agriculture. The disease is more often observed in people living in rainy areas with high humidity.

Despite the fact that all cases of endemic Balkan nephropathy are of a family nature, the hereditary conditionality of it is questionable. In family members who left their homes at an early age, endemic Balkan nephropathy develops much less frequently.  

In persons whose relatives suffered from this disease, born outside the Danube basin, when moving to a permanent place of residence in the region, on the contrary, endemic Balkan nephropathy occurs very often. In connection with this, we repeatedly tried to search for environmental factors (intoxication with lead, silicon, cadmium, selenium, viruses, toxins of fungi or plants), responsible for the development of this tubulointerstitial nephropathy, but their results are still unconvincing.

[8], [9], [10],

Symptoms of the endemic Balkan Nephropathy

Endemic Balkan nephropathy makes its debut at the age of 30-50 years with predominantly tubular disorders. In the future, there is a violation of the concentration function of the kidneys and progressive renal failure. Arterial hypertension is not typical.

The average term of progression of endemic Balkan nephropathy is 20 years. The disease predisposes to the development of carcinomas of the urinary tract.

[11], [12], [13], [14],

Diagnostics of the endemic Balkan Nephropathy

Diagnosis of endemic Balkan nephropathy consists in the application of clinical indicative criteria:

• symmetrically reduced kidneys without calcification;
• the patient lives in a rural area and an endemic region;
• cases of a family history.

Laboratory diagnosis of endemic Balkan nephropathy

Laboratory indicative criteria for endemic Balkan nephropathy:

• small tubular proteinuria;
• hypostenuria;
• normochromic normocytic anemia (often observed already in the onset of the disease).

In the early stages of endemic Balkan nephropathy  tubular proteinuria  (an increase in the excretion of beta _2- microglobulin), as well as glucosuria and aminoaciduria are detected  .

[15], [16], [17], [18], [19], [20], [21],

Instrumental diagnosis of endemic Balkan nephropathy

Morphological signs of endemic Balkan nephropathy - tubular atrophy, edema of interstitium, single macrophages. An edema of the endothelium of interstitial capillaries is also found. As the disease progresses, tubulointerstitial fibrosis grows. The size of the kidneys decreases symmetrically.

Treatment of the endemic Balkan Nephropathy

Treatment of endemic Balkan nephropathy has not been developed. With irreversible deterioration of renal function, methods of renal replacement therapy are used.