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BackgroundPrevious studies have linked smaller kidney dimensions to increased blood pressure. However, patients with Balkan Endemic Nephropathy (BEN), whose kidneys shrink during the course of the disease, do not manifest increased blood pressure. The authors evaluated the relationship between kidney cortex width, kidney length, and blood pressure in the offspring of BEN patients and controls.Methods102 offspring of BEN patients and 99 control offspring of non-BEN hospital patients in the Vratza District, Bulgaria, were enrolled in a prospective study and examined twice (2003/04 and 2004/05). Kidney dimensions were determined using ultrasound, blood pressure was measured, and medical information was collected. The parental disease of BEN was categorized into three groups: mother, father, or both parents. Repeated measurements were analyzed with mixed regression models.ResultsIn all participants, a decrease in minimal kidney cortex width of 1 mm was related to an increase in systolic blood pressure of 1.4 mm Hg (p = 0.005). There was no association between kidney length and blood pressure. A maternal history of BEN was associated with an increase in systolic blood pressure of 6.7 mm Hg (p = 0.03); paternal BEN, +3.2 mm Hg (p = 0.35); or both parents affected, +9.9 mm Hg (p = 0.002). There was a similar relation of kidney cortex width and parental history of BEN with pulse pressure; however, no association with diastolic blood pressure was found.ConclusionIn BEN and control offspring, a smaller kidney cortex width predisposed to higher blood pressure. Unexpectedly, a maternal history of BEN was associated with average increased systolic blood pressure in offspring.

Background: The etiology of Balkan Endemic Nephropathy, (BEN), a tubulointerstitial kidney disease, is unknown. Although this disease is endemic in rural areas of Bosnia, Bulgaria, Croatia, Romania, and Serbia, similar manifestations are reported to occur in other regions, for instance Tunisia and Sri Lanka. A number of explanations have been stated including lignites, aristolochic acid, ochratoxin A, metals, and metalloids. Etiologic claims are often based on one or a few studies without sound scientific evidence. In this systematic study, we tested whether exposures to metals (cadmium and lead) and metalloids (arsenic and selenium) are related to Balkan Endemic Nephropathy.

High sodium intake is associated with increased blood pressure and and increased risk of cardiovascular disease (CVD). Among the countries of the European Union, Bulgaria ranks first in mortality from CVD. Genetically determined salt sensitivity is present in 50% of the hypertensive and 26% of the normotensive population, posing a major public health problem. The present study was conducted within the National Program for Prevention of Chronic Non-Communicable Diseases 2014 - 2020 to assess the sodium intake of the population in Bulgaria. 36 normotensive participants are included in the study. DNA from each volunteers was isolated and genotyped for rs10177833 (A>C) in SLC4A5 gene by TaqMan SNP genotyping assay. To determine the 24-hour urinary excretion of sodium in the subjects, a random sample was taken from each participant. Sodium concentration was determined by atomic absorption spectrometry. A WHO protocol has been used to recalculate sodium excretion (Protocol for Sodium Determination in 24-hour Urine Samples). Eighteen of total of 35 participants had wild AA genotype (51.43%), thirteen were heterozygotes (37.14%) and four were carriers of two polymorphic C alleles (11.43%). The frequency of A allele of rs10177833 (A>C) in SLC4A5 gene was 70%, whereas polymorphic C allele was only 30%. The correlation analysis showed negative statistical significant relationship between rs10177833 in SLC4A5 gene and sodium concentration (in milligrams) in 24 - hours urine (r = -0.365, p = 0.031). Also the holders of CC genotype had significant lower values of Na compared to these with wild AA genotype (p = 0.01) and compared to heterozygotes (p = 0.019). In conclusion, we found a clear relationship between the polymorphic variant rs10177833 in SLC4A5 gene and the concentration of sodium in urine in Bulgarian normotensives. The tendency of association was found between the studied polymorphic variant and blood pressure values, which should be studied in a large number of participants Key messages Increasing the population's awareness of health risks with increased salt consumption. Regular monitoring of salt consumption.