Investigation of Balkan endemic nephropathy in Serbia: How to proceed?

Author:

Djukanovic Ljubica1,Stefanovic Vladisav1,Basta-Jovanovic Gordana2,Bukvic Danica3,Glogovac Stevan4,Dimitrijevic Jovan5,Djuric Suncica6,Jankovic Slavenka2ORCID,Lukic Ljiljana7,Maric Ivko3,Nikolic Jovan5,Novakovic Ivana2ORCID,Pejovic Vesna3,Radisavljevic Snezana6,Rakic R8

Affiliation:

1. Akademija medicinskih nauka, Srpsko lekarsko društvo, Beograd

2. Medicinski fakultet, Beograd

3. Specijalna bolnica za endemsku nefropatiju, Lazarevac

4. Zdravstveni centar, Leskovac

5. Institut za urologiju i nefrologiju, Klinički centar Srbije, Beograd

6. Zdravstveni centar, Ćuprija

7. Internacionalni dijaliza centar, Bijeljina, Republika Srpska

8. Zdravstveni centar, Požarevac

Abstract

Balkan endemic nephropathy (BEN) presents an unsolved puzzle despite fifty years of its investigation. Academy of Medical Sciences of the Serbian Medical Society organized a round table discussion on current unsolved problems related to BEN. The present paper summarizes presentations, discussion and conclusions of this meeting. During the last fifty years, the course of BEN prolonged and it shifted towards the older age in all endemic foci. Data on the incidence of BEN have been controversial and frequently based on the data on the number of BEN patients starting haemodialysis treatment. In Serbia, BEN patients present 6.5% of haemodialysis population and this percentage differs among different centres ranging from 5% (Leskovac) to 46% (Lazarevac). Maintenance of high prevalence of BEN patients on regular haemodialysis indicates that BEN is not an expiring disease. In addition, recent data have shown more frequent microalbuminuria and low-molecular weight proteinuria in children from endemic than from nonendemic families. Aetiology of BEN is still unknown despite numerous investigations of environmental and genetic factors. Today, there is a very current hypothesis on the aetiological role of aristolochic acid but the role of viruses, geochemical factors and genetic factors must not be neglected. Morphological features of BEN are nonspecific and characterized by acellular interstitial fibrosis, tubular atrophy and changes on preand postglomerular vessels. New immunohistochemical and molecular biology methods offer a new approach to BEN investigation. Association of BEN with high incidence of upperurothelial tumours is well-known. Recent studies have shown significant changes of demographic characteristics of patients suffering upper-urothelial tumours, their prevalence in different endemic foci and characteristics of tumours. Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.

Publisher

National Library of Serbia

Subject

General Medicine

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