Endemic Balkan nephropathy

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

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Epidemiology

The disease endemic Balkan nephropathy is observed only in the Danube River basin in Serbia, Romania, Bosnia and Herzegovina, Croatia and Bulgaria. Endemic Balkan nephropathy is familial.

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Causes of endemic Balkan nephropathy.

The causes and risk factors of endemic Balkan nephropathy have not been established. All patients usually work in agriculture. The disease is more often observed in people living in rainy areas with high humidity.

Although all cases of endemic Balkan nephropathy are familial, its hereditary nature is questionable. In family members who left their place of residence 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 this region, on the contrary, endemic Balkan nephropathy occurs very often. In this regard, there have been repeated attempts to look for environmental factors (poisoning with lead, silicon, cadmium, selenium, viruses, fungal or plant toxins) responsible for the development of this tubulointerstitial nephropathy, but their results are still unconvincing.

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Symptoms of endemic Balkan nephropathy.

Endemic Balkan nephropathy debuts at the age of 30-50 years with predominantly tubular disorders. Later, impaired renal concentration function and progressive renal failure join in. Arterial hypertension is not typical.

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

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Diagnostics of endemic Balkan nephropathy.

Diagnosis of endemic Balkan nephropathy is based on the use of clinical reference criteria:

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

Laboratory diagnostics of endemic Balkan nephropathy

Laboratory criteria for endemic Balkan nephropathy:

• slight tubular proteinuria;
• hyposthenuria;
• normochromic normocytic anemia (often observed at the onset of the disease).

In the early stages of endemic Balkan nephropathy, tubular proteinuria (increased excretion of beta ₂ -microglobulin), as well as glucosuria and aminoaciduria are detected.

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Instrumental diagnostics of endemic Balkan nephropathy

Morphological signs of endemic Balkan nephropathy are tubular atrophy, interstitial edema, and isolated macrophages. Edema of the endothelium of interstitial capillaries is also detected. As the disease progresses, tubulointerstitial fibrosis increases. The kidney sizes decrease symmetrically.

Treatment of endemic Balkan nephropathy.

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