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.

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease described only in some rural parts of southeastern Europe. One of its most peculiar characteristics is a strong association with upper urothelial cancer (UUC). BEN-related UUC has the same histological features as other forms of UUC in general, but is more frequently bilateral, less frequently affects the bladder and has a sex ratio close to 1. BEN and BEN-associated UUC share the same etiology. Over time, incidence of these conditions has been declining. Since BEN was first described, around half a century ago, socioeconomic changes (in housing, farming, living standards, etc.) have been profound and have obscured the factors responsible for the observed reduction in incidence. Whatever the causes of BEN, the disease might not be restricted only to southeastern Europe. Rather, the intensity of exposure to risk factors for BEN and, consequently, clustering of cases has more likely determined our knowledge of topographical distribution of an etiological entity that is much more widespread, or that might even be ubiquitous in its sporadic form.

SynopsisThe General Health Questionnaire (GHQ) was shown to be a valid instrument for the screening of psychological impairment in a defined population of Yugoslav students. Optimal indices of validity were obtained by the use of the 60-item version of the GHQ and a cut-off score of 13/14. The product-moment correlation coefficients between clinical ratings of severity of mental impairment and GHQ scores ranged from 0·71 to 0·78.

Background: Kuwait has one of the highest consanguinity rates in the world. Our objectives in this study wereto assess the frequency and trend in consanguineous marriages, and to identify factors associated with inbreeding. Patients and Methods: A representative sample of 482 households from the most developed (the Capital), and the least developed (Jahra), of the five governorates in Kuwait was selected. The study involved only Kuwaiti nationals. A structured questionnaire was administered by previously trained team members through a household face-to-face interview. Results: Data were obtained for 959 current or previous marriages. Frequency of total (first and second cousin) consanguinity was much higher in Jahra governorate (42.1%) than the Capital (22.6%). Over the last decade, the inbreeding has decreased in the Capital but not in Jahra. Bivariate analysis indicated that several socioeconomic and demographic variables were significantly associated with consanguinity. The control of confounding factors by logistic regression showed, however, that Bedouin origin and year of marriage were the only variables significantly related to consanguinity. Conclusion: There is a widening gap between Bedouins and non-Bedouins in the practice of consanguinity in Kuwait.

Balkan endemic nephropathy (BEN), a kidney disease that occurs in rural villages in Bosnia, Bulgaria, Croatia, Romania, and Serbia, is thought to be linked to an environmental toxin. The authors review literature on proposed environmental exposure agents, report the results of field sampling and analysis studies to evaluate potentials for exposure to proposed agents, and propose criteria for future testing. They used these criteria to evaluate the evidence for suggested hypotheses, concluding that several proposed agents can be eliminated or considered unlikely based on apparent inconsistencies between clinical or epidemiologic evidence related to BEN and toxicologic or exposure evidence related to the agents. Mycotoxins and aristolochic acid are the primary targets of current toxicologic investigations, and while the evidence on exposures for both is potentially consistent, it is insufficient.