Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Balkan endemic nephropathy: Still a mysterious disease

  • 39 Accesses

  • 49 Citations

Abstract

Balkan endemic nephropathy (BEN) is an acquired, environmental, polytopical disease of the entire urinary tract, with long latency. Tubulo-interstitial chronic nephritis, urotheliomas of all localities, and renal cell carcinoma occur with a significantly higher frequency in the affected population. These represent only clinical manifestations of one unique nosological entity. BEN occurs in focuses. Within them, it agglomerates in households, without any evidence of hereditary background. Patients with various clinical manifestations of the disease can be simultaneously found within one single household. BEN appears equally among members of different ethnic groups. Its aetiology is not clear enough. There is no evidence of a causal relationship with silicon compounds, heavy metals and viruses. Much attention has been recently focused on research of the aetiological role of mycotoxins, mainly ochratoxin A. Toxic and carcinogenic agents of natural origin are commonly accepted as the major cause of BEN.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Božić Z. Epidemiologija i etiologija urogenitalnog karcinoma. Panonsko-balkanska endemična uropatija. In: Novak R, Tucak A, eds, Urološka onkologija. Zagreb: Medicinska naklada, 1994: 9–10.

  2. 2.

    Kuzmanić D. Tubulointersticijske bolesti bubrega. In: Vrhovac B, Bakran I, Granić M, Jakšić B, Labar B, Vucelić B, eds, Interna medicina. Zagreb: Naprijed, 1991: 1211–1217.

  3. 3.

    Radonić M, Radošević Z. Clinical features of Balkan endemic nephropathy. Food Chem Toxicol 1992; 30 (3): 189–192.

  4. 4.

    Castegnaro M, Chernozemsky IN, Heitanen E, Bartsch H. Are mycotoxins risk factors for endemic nephropathy and associated urothelial cancers? Arch Geschwulstforsch 1990; 60 (4): 295–303.

  5. 5.

    Castegnaro M, Bartsch H, Chernozemsky I. Endemic nephropathy and urinary tract tumors in the Balkans. Cancer Res 1987; 47: 3608–3609.

  6. 6.

    Chernozemsky IN. Balkan endemic nephropathy and associated tumours of urinary system: A summary of epidemiological features in Bulgaria. IARC Scientific Publications 1991; 115: 3–4.

  7. 7.

    Čeović S, Pleština R, Miletić-Medved M, Stavljenić A, Mitar J, Vukelić M. Epidemiological aspects of Balkan endemic nephropathy in a typical focus in Yugoslavia. IARC Scientific Publications 1991; 115: 5–10.

  8. 8.

    Čeović S, Hrabar A, Šarić M. Epidemiology of Balkan endemic nephropathy. Food Chem Toxicol 1992; 30 (3): 183–188.

  9. 9.

    Marković B. Néphropathie des Balkans et carcinome àcellules transitionnelles. J Urol (Paris) 1985; 91 (4): 215–220.

  10. 10.

    Marković B. Néphropathies des Balkans et cancer urothé1ial. J Urol (Paris) 1990; 96 (6): 349–352.

  11. 11.

    Mihajlov T. Family grouping of excretory system tumors of patients with Balkan endemic nephropathy. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983; 249–251.

  12. 12.

    Nikolić J, Popović J. Tumors of the pielum and ureter in emigrants from nephropathy areas. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 245–248.

  13. 13.

    Petković S. Comments on certain correlations between Endemic nephropathy and tumors of the upper urothelium. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 235–237.

  14. 14.

    Radovanović Z. Epidemiological characteristics of Balkan endemic nephropathy in eastern regions of Yugoslavia. IARC Scientific Publications 1991; 115: 11–20.

  15. 15.

    Radovanović Z, Velimirović D, Naumović T. Upper urothelial tumours and the Balkan nephropathy. Eur J Cancer 1990; 26 (3): 391–392.

  16. 16.

    Šoštarić B, Vukelić M. Characteristics of urinary tract tumours in the area of Balkan endemic nephropathy in Croatia. IARC Scientific Publications 1991; 115: 29–35.

  17. 17.

    Tanchev Y, Dorossiev D. The first clinical description of Balkan endemic nephropathy (1956) and its validity 35 years later. IARC Scientific Publications 1991; 115: 21–28.

  18. 18.

    Čeović S, Hrabar A, Radonjić M, et al. Distribution of Balkan endemic nephropathy in the region of Slavonski Brod, Croatia, Yugoslavia. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 257–268.

  19. 19.

    Čukuranović R, Dinić A, Ignjatović M, Strahinjić S, Stefanović V. Tumori urotrakta u slivu Južne Morave i njenih pritoka. Epidemiološka studija. In: Zbornik radova 6. internacionalnog simpozija urologa, Niš, 1987. Niš: Urološka sekcija srpskog lekarskog društva, 1987: 123–140.

  20. 20.

    Radovanović Z, Krajinović S. Balkan endemic nephropathy and urinary tract tumors. Arch Geschwulsforsch 1978; 49: 444–447.

  21. 21.

    Radovanović Z, Krajinović P, Janković P, Hall Ph, Petković S. Family history of cancer among cases of upper urothelial tumors. J Cancer Res Clin Oncol 1985; 3: 330–332.

  22. 22.

    Marković B. Néphropathie des Balkans. J Urol (Paris) 1990; 96 (1): 31–35.

  23. 23.

    Vukelić M, Šoštarić B, Belicza M. Pathomorphology of Balkan endemic nephropathy. Food Chem Toxicol 1992; 30 (3): 193–200.

  24. 24.

    Dimitrov T. Clinical and morphological stages of Balkan endemic nephropathy. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 71–72.

  25. 25.

    Marković B. Endemic nephritis and urinary tract cancer in Yugoslavia, Bulgaria and Rumania. J Urol 1972; 107: 212–219.

  26. 26.

    Pichler O, Bobinac E, Miljuš B, Sindik A. O učestaloj pojavi bubrežnih oboljenja u okolici Slavonskog Broda. Lij Vjes 1959; 81: 295–306.

  27. 27.

    Pleština R. Some features of Balkan endemic nephropathy. Food Chem Toxicol 1992; 30 (3): 177–181.

  28. 28.

    Gaon AJ, Dedić I, Telebak B, Turić A. Occurrence of endemic nephropathy in SR BiH. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 263–267.

  29. 29.

    Mihajlov T, Ivanova P, Stojcheva A. Epidemiology of Balkan endemic nephropathy in Bulgaria. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 277–278.

  30. 30.

    Stefanović V, Strahinjić S, Petrović V, et al. Endemic (Balkan) nephropathy is uniformly spread in endemic villages (Brestovac and Kutleš) around the South Morava river. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 315–317.

  31. 31.

    Mihajlov T, Boev P. Ethnic types having endemic nephropathy: ‘White Gypsies’. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 287–290.

  32. 32.

    Chernozemsky IN, Petkova-Bocharova T, Stoyanov IS, et al. Epidemiologic data for environmental determination of urinary system tumors and nephropathy in an endemic region. Arch Geschwulstforsch 1978; 48: 746–760.

  33. 33.

    Gaon JA. Epidemiological investigation of endemic (Balkan) nephropathy with particular reference to the former testing of the hypotheses on etiology of the disease. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 17–22.

  34. 34.

    Goyer RA. Urinary system. In: Karle Mottet N, ed, Environmental pathology. Oxford: Oxford University Press, 1985: 312.

  35. 35.

    Radovanović Z. Aetiology of Balkan nephropathy: A reappraisal after 30 years. Eur J Epidemiol 1989; 5 (3): 372–377.

  36. 36.

    Naumović T, Stamenković M, Joksimović LJ, Velimirović D. Frequency of endemic nephropathy and tumors of the urothelium in the Kolubara region. In: Current research in endemic (Balkan) nephropathy. Niš: University Press, 1983: 269–276.

  37. 37.

    Radovanović Z, Naumović T, Velimirović D. Clustering of the upper urothelial tumours in a family. Oncology 1984; 41: 396–398.

  38. 38.

    Bach PH, Gregg NJ, Delacruz L. Relevance of a rat model of papillary necrosis and upper urothelial carcinoma in understanding the role of ochratoxin A in Balkan endemic nephropathy and its associated carcinoma. Food Chem Toxicol 1992; 30 (3): 205–211.

  39. 39.

    Hald B. Porcine nephropathy in Europe. IARC Scientific Publications 1991; 115: 49–56.

  40. 40.

    Hald B. Ochratoxin A in human blood in European countries. IARC Scientific Publications 1991; 115: 159–164.

  41. 41.

    Frank HK. Food contamination by ochratoxin A in Germany. IARC Scientific Publications 1991; 115: 77–81.

  42. 42.

    Frank HK. Risk estimation for ochratoxin A in European countries. IARC Scientific Publications 1991; 115: 321–325.

  43. 43.

    Fuchs R, Radić B, Čeović S, Šoštarić B, Hult K. Human exposure to ochratoxin A. IARC Scientific Publications 1991; 115: 131–134.

  44. 44.

    Mantle PG, McHugh KM, Adatia R, Heaton JM, Gray T, Turner DR. Penicillium aurantiogriseum-induced, persistent renal histopathological changes in rats: An experimental model for Balkan endemic nephropathy competitive with ochratoxin A. IARC Scientific Publications 1991; 115: 119–127.

  45. 45.

    Petkova-Bocharova T, Castegnaro M, Michelon J, Maru V. Ochratoxin A and other mycotoxins in cereals from an area of Balkan endemic nephropathy and urinary tract tumours in Bulgaria. IARC Scientific Publications 1991; 115: 83–87.

  46. 46.

    Castegnaro M, Maru V, Petkova-Bocharova T, Nikolov I, Bartsch H. Concentrations of ochratoxin A in the urine of endemic nephropathy patients and controls in Bulgaria: Lack of detection of 4-hydroxy-ochratoxin A. IARC Scientific Publications 1991; 115: 165–169.

  47. 47.

    Petkova-Bocharova T, Chernozemsky IN, Castegnaro M. Ochratoxin A in human blood in relation to Balkan endemic nephropathy and urinary system tumours in Bulgaria. Food Addit Contam 1988; 5 (3): 299–301.

  48. 48.

    Petkova-Bocharova T, Castegnaro M. Ochratoxin A in human blood in relation to Balkan endemic nephropathy and urinary tract tumours in Bulgaria. IARC Scientific Publications 1991; 115: 135–137.

  49. 49.

    Krogh P. Role of ochratoxin on disease causation. Food Chem Toxicol 1992; 30 (3): 213–224.

  50. 50.

    Kuiper-Goodman T. Risk assessment of ochratoxin A residues in food. IARC Scientific Publications 1991; 115: 307–320.

  51. 51.

    Huff JE. Carcinogenity of ochratoxin A in experimental animals. IARC Scientific Publications 1991; 115: 229–244.

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Božić, Z., Duančić, V., Belicza, M. et al. Balkan endemic nephropathy: Still a mysterious disease. Eur J Epidemiol 11, 235–238 (1995). https://doi.org/10.1007/BF01719495

Download citation

Key words

  • Balkan nephropathy
  • Interstitial nephritis
  • Kidney neoplasms
  • Transitional cell carcinoma