Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers.

Bio ke mij ski bi lje zi preg rad nje kos ti ju -preg led Bioc he mi cal mar ke rs of bo ne re mo de li ng -re viewIva na Če pe lak 1 , Dub rav ka Čvo riš ćec 2 1 Zavod za me di cin sku bio ke mi ju i he ma to lo gi ju Far ma ceut sko-bio ke mij skog fa kul te ta Sveu či liš ta u Zag re bu, Zagreb 1 De par tme nt of Me di cal Bioc he mis try and He ma to lo gy, Fa cul ty of Phar ma cy and Bioc he mis try, Uni ver si ty of Zag reb, Zagreb, Croatia 2 Kli nič ki za vod za la bo ra to rij sku di jag nos ti ku Me di cin skog fa kul te ta Sveu či liš ta u Zag re bu i KBC Zag reb, Zagreb 2 Cli ni cal In sti tu te of La bo ra to ry Diag nos tic, School of Me di ci ne, Uni ver si ty of Zag reb and Cli ni cal Hos pi tal Cen ter Zag reb, Zagreb, Croatia Sa že takDa nas je u upot re bi niz bio ke mij skih bi lje ga preg rad nje kos ti ju, uk lju ču jući bi lje ge iz grad nje i raz grad nje kos ti ju. Oni pru ža ju kli nič ki ko ris ne do ka ze nor ma lnih i pa to loš kih pro ce sa, ko ji od ra ža va ju ak tiv nos ti koš ta nih sta ni ca u ske le tu. Bio loš ki bi lje zi preg rad nje kos ti ju mo gu se ko ris ti ti za pra će nje uči naka te ra pije kod bo les ni ka s nekom od bo les ti kos ti ju te za mo gu će sma nje nje pot re be čes tog mje re nja gus to će koš ta ne ma se (den zi to met ri je). Ključ ne ri je či: bi lje zi iz grad nje kos ti ju; bi lje zi raz grad nje kos ti ju; os teo poroza Ab stra ctA num ber of bioc he mi cal mar ke rs of bo ne re mo de li ng whi ch in clu de bo ne for ma tion and bo ne re sor ption mar ke rs are cur ren tly in use. They pro vi de clini cal ly use ful evi den ce of the nor mal and pat ho lo gi cal pro ces ses that refl e ct bo ne ce ll ac ti vities in the ske le ton. Bio mar ke rs of bo ne re mo deling can be used to do cu me nt the eff ec ts of the ra peu tic agen ts in so me pa tien ts wi th bone di sea ses and pos sib ly redu ce the need for freque nt bo ne den si ty tes ti ng. Key wor ds: bone for ma tion mar ke rs; bo ne re sor ption mar ke rs; os teo po ro sis

Background/Aims: An epidemiological survey of endemic nephropathy (EN) was performed in endemic Croatian areas and the current prevalence was compared to that reported for the same villages several decades ago. Methods: A total of 2,487 adult farmers from 6 endemic villages and 3 non-endemic villages were enrolled. An extensive epidemiological questionnaire, clinical examination and laboratory analyses of blood and urine were performed. According to the modified WHO criteria, participants were classified into diseased, suspected of having EN, and those at risk of developing EN. Results: The overall prevalence of EN in the Croatian areas was 1.0%, ranging between 0.3 and 2.3% in different villages. Those suspected of having EN amounted to 3.9%. In the endemic villages a decreasing trend in the prevalence of EN was observed comparable to the results obtained in previous surveys. It is interesting to note that no EN patients were recorded in the endemic village of Dubočac. Conclusion: The prevalence of EN in the endemic Croatian areas appears to be decreasing. For the first time, we failed to detect any EN patients in a village that was previously considered endemic, which might indicate that EN is diminishing.