Comparison of Kidney Size between Patients with Balkan Endemic Nephropathy and Other Kidney Diseases

Introduction. Balkan endemic nephropathy (BEN) patients maintained with hemodialysis have more severe anemia than patients with other kidney diseases. Objective. The aim of the study was to compare the improvement of anemia in BEN patients and those with other kidney diseases during treatment with human recombinant erythropoietin (rHuEpo). Methods. The study involved 240 patients on regular hemodialysis for more than one year. Out of them 146 had BEN and 94 other kidney diseases (21 glomerulonephritis, 20 hypertension, 18 diabetes, 10 policystic kidney disease, 5 obstructive nephropathy, 18 other diseases). Treatment with rHuEpo was carried out according to European guidelines for the management of anemia. Results. Patients with BEN were older and were less frequently treated with ACEi than patients with other kidney diseases. At the onset of the study mean hemoglobin level (109.6?22.3 vs. 112.7?11.3 g/l) was significantly lower, but serum ferritin level and rHuEpo dose (65.4?22.3 vs. 57.5?22.5 U/kg/week) were significantly higher in BEN patients than in others. In prospective four months study these differences in hemoglobin levels and rHuEpo doses maintained. The rate of anemia improvement was examined in 15 BEN patients and 10 patients with other kidney diseases at the beginning of rHuEpo treatment. No difference in the rate of anemia improvement was found between the two groups but higher rHuEpo doses were used in BEN patients. Conclusion. Patients with BEN on regular hemodialysis had more severe anemia and required higher rHuEpo doses for maintaining target hemoglobin level.

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Organic Compounds Derived from Pliocene Lignite and the Etiology of Balkan Endemic Nephropathy

Geology and Health ◽

10.1093/oso/9780195162042.003.0034 ◽

2003 ◽

Author(s):

Calin A. Tatu ◽

Victor Dumitrascu

Keyword(s):

Kidney Diseases ◽

Renal Dialysis ◽

Disease Diagnosis ◽

Rapid Onset ◽

Danube River ◽

Balkan Endemic Nephropathy ◽

Normocytic Anemia ◽

Clinical Onset ◽

Endemic Nephropathy ◽

Stage Renal Disease

Acknowledged for the first time as a medical entity in the late 1950s, Balkan endemic nephropathy (BEN) is a chronic and irreversible kidney disease of unknown cause. BEN is geographically confined to several rural regions of central and southeastern Serbia, southwestern Romania, northwestern Bulgaria, southeastern Croatia, and parts of Bosnia and Kosovo, confined to the alluvial valleys of tributaries of the lower Danube River (Ceovic et al. 1992, Hall 1992, Tatu et al. 1998). It is estimated that several thousand people in the affected countries are currently suffering from the disease, and that thousands more will be diagnosed with BEN in the next few years. Although no single feature is sufficient for disease diagnosis, BEN has several characteristics that allow it to be distinguished from other chronic kidney diseases: These characteristics are: . . . ·The age of clinical onset is usually between 30 and 50 years, with a slightly higher frequency in women (female:male sex ratio is ~1.5:1), probably due to some social and genetic factors. . . . . . . ·There is a long subclinical “incubation” period and a rapid onset of end-stage renal disease; the only therapeutic solutions left are chronic renal dialysis or kidney transplantation. . . . . . . ·There is a family history of the disease, with an aggregation of the disease in certain households. . . . . . . ·BEN patients exhibit normal blood pressure in ~80% of the cases (a feature unusual for most other kidney diseases) and normochromic and normocytic anemia is common in BEN. . . . . . . ·BEN patients have lived for at least 10-20 years in one or more of the endemic villages. A slight decrease in the incidence of the disease has been noticed in the last two years in Serbia and Romania (Cukuranovic et al. 2000); however, this seems to follow the usual oscillating pattern of the disease, with lows and highs of incidence, and another epidemic outbreak is likely to occur in these areas in the future. . . .

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Creatinine clearance and kidney size in Balkan endemic nephropathy patients

Clinical Nephrology ◽

10.5414/cnp61384 ◽

2004 ◽

Vol 61 (06) ◽

pp. 384-386 ◽

Cited By ~ 11

Author(s):

L. Djukanovic ◽

D. Bukvic ◽

I. Maric

Keyword(s):

Creatinine Clearance ◽

Balkan Endemic Nephropathy ◽

Kidney Size ◽

Endemic Nephropathy

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Reduced Kidney Size in Adult Offspring of Balkan Endemic Nephropathy Patients and Controls: A Prospective Study

The American Journal of the Medical Sciences ◽

10.1097/maj.0b013e3181e2353e ◽

2010 ◽

Vol 340 (2) ◽

pp. 94-102 ◽

Cited By ~ 2

Author(s):

Kesinee Hanjangsit ◽

Wilfried Karmaus ◽

Plamen Dimitrov ◽

Svetla Tsolova ◽

Vecihi Batuman ◽

...

Keyword(s):

Prospective Study ◽

Balkan Endemic Nephropathy ◽

Adult Offspring ◽

Kidney Size ◽

Endemic Nephropathy ◽

A Prospective Study

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Prevalence and risk factors of vascular calcification in pre-dialysis patients with Balkan endemic nephropathy

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1612608p ◽

2016 ◽

Vol 144 (11-12) ◽

pp. 608-614 ◽

Cited By ~ 2

Author(s):

Nenad Petkovic ◽

Radmil Maric ◽

Radoslav Gajanin ◽

Danijela Batinic ◽

Mirjana Cuk ◽

...

Keyword(s):

Risk Factors ◽

Serum Concentration ◽

Arterial Wall ◽

Kidney Diseases ◽

Matrix Gla Protein ◽

Balkan Endemic Nephropathy ◽

Dialysis Patients ◽

Lower Serum ◽

Endemic Nephropathy ◽

Bone Morphogenic Protein 2

Introduction. Vascular calcifications (VC) are common in patients with chronic kidney disease and present one of manifestations of mineral and bone disorders in these patients. Objective. The aim of this pilot study was to examine the prevalence and risk factors of VC in pre-dialysis patients with Balkan endemic nephropathy (BEN) and other kidney diseases. Methods. The study involved 32 pre-dialysis patients, 15 with BEN and 17 with other kidney diseases. All the patients underwent an interview, objective examination, routine laboratory analyses and measurement of serum concentration of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 [25(OH)D3] and osteopontin. VCs in iliac, femoral, radial, and digital arteries were evaluated and Adragao VC score was calculated. The samples of radial artery were collected during the first creation of an arteriovenous fistula, and expression of osteocalcin, bone morphogenic protein-2 osteopontin, and matrix Gla-protein in arterial wall were examined. Results. Patients with BEN were significantly older (71.1 ? 6.1 vs. 54.7 ? 11.1 years), but they had significantly lower systolic and mean blood pressure (95.7 ? 13.2 mmHg vs. 104.3 ? 7.4 mmHg) and lower serum concentration of phosphorus (1.32 ? 0.36 mmol/l vs. 1.65 ? 0.35 mmol/l) and cholesterol (4.3 ? 1.1 mmol/l vs. 5.2 ? 0.8 mmol/l) than patients with other kidney diseases. Mean VC score was significantly lower in patients with BEN than in those with other kidney diseases (2.8 ? 1.7 vs. 4.6 ? 1.8; p = 0.009), but expression of four examined proteins in arterial wall differed insignificantly between the two groups. VC score correlated significantly with serum concentrations of cholesterol, triglycerides (positively), and iPTH (negatively). Conclusion. Pre-dialysis BEN patients had a significantly lower mean score of VC than patients with other kidney diseases.

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Ocular fundus abnormalities in patients with Balkan endemic nephropathy and other chronic kidney diseases

International Urology and Nephrology ◽

10.1007/s11255-015-1078-x ◽

2015 ◽

Vol 47 (10) ◽

pp. 1693-1701 ◽

Cited By ~ 2

Author(s):

Jasmina Djordjevic Jocic ◽

Rade Cukuranovic ◽

Predrag Jovanovic ◽

Vidosava Djordjevic ◽

Marija Mihajlovic ◽

...

Keyword(s):

Kidney Diseases ◽

Balkan Endemic Nephropathy ◽

Chronic Kidney Diseases ◽

Ocular Fundus ◽

Endemic Nephropathy

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Aristolochic Acids: Newly Identified Exposure Pathways of this Class of Environmental and Food-Borne Contaminants and its Potential Link to Chronic Kidney Diseases

Toxics ◽

10.3390/toxics7010014 ◽

2019 ◽

Vol 7 (1) ◽

pp. 14 ◽

Cited By ~ 8

Author(s):

Chi-Kong Chan ◽

Yushuo Liu ◽

Nikola Pavlović ◽

Wan Chan

Keyword(s):

Kidney Diseases ◽

Balkan Peninsula ◽

Danube River ◽

Herbal Remedies ◽

Balkan Endemic Nephropathy ◽

Chronic Kidney Diseases ◽

Aristolochic Acids ◽

Causative Agents ◽

Endemic Nephropathy ◽

Potential Link

Aristolochic acids (AAs) are nitrophenanthrene carboxylic acids naturally produced by Aristolochia plants. These plants were widely used to prepare herbal remedies until AAs were observed to be highly nephrotoxic and carcinogenic to humans. Although the use of AA-containing Aristolochia plants in herbal medicine is prohibited in countries worldwide, emerging evidence nevertheless has indicated that AAs are the causative agents of Balkan endemic nephropathy (BEN), an environmentally derived disease threatening numerous residents of rural farming villages along the Danube River in countries of the Balkan Peninsula. This perspective updates recent findings on the identification of AAs in food as a result of the root uptake of free AAs released from the decayed seeds of Aristolochia clematitis L., in combination with their presence and fate in the environment. The potential link between AAs and the high prevalence of chronic kidney diseases in China is also discussed.

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Balkan endemic nephropathy

10.1093/med/9780199592548.003.0090_update_001 ◽

2018 ◽

Author(s):

Milan Radović ◽

Adalbert Schiller

Keyword(s):

Interstitial Fibrosis ◽

Positive Family History ◽

Balkan Peninsula ◽

Balkan Endemic Nephropathy ◽

Tubular Proteinuria ◽

Contributing Factors ◽

Tubular Atrophy ◽

Kidney Size ◽

Salt Wasting ◽

Endemic Nephropathy

Balkan endemic nephropathy (BEN) is a chronic, slowly progressive tubulointerstitial nephritis, with familial clustering, occurring in several endemic rural regions in countries of the Balkan Peninsula. BEN is characterized by anaemia, tubular proteinuria, renal shrinkage, and slowly declining glomerular filtration rate (GFR). Up to one-third of patients may also develop upper urothelial tumours. The aetiology of BEN is unclear; chronic exposure to aristolochic acid and a polygenic predisposition are the most likely contributing factors. The major pathological characteristics of BEN are symmetrically shrunken, smooth-shaped kidneys, with interstitial fibrosis, mild interstitial inflammation, and tubular atrophy. Diagnosis is usually based upon positive family history of BEN, past or current residence in endemic regions, tubular proteinuria, tubular dysfunctions (such as urine acidification defects, salt wasting, and impaired excretion of ammonia, uric acid, and phosphate), scant urinary sediment, bilateral and symmetrically reduced kidney size, accompanied by severe anaemia, disproportionate to the degree of GFR reduction. There is no specific therapy for BEN; patients should therefore be treated as all patients with chronic kidney disease, in general. The use of distant water supplies or moving to another residence area should be advised to affected families. Careful evaluation for urothelial cancers is mandatory in patients with haematuria.

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