Aetiology of Balkan nephropathy: A reapprisal after 30 years

Abstract

Balkan nephropathy (BN) has been a complete aetiological puzzle for many years. Intense research produced many controversial results, but also helped some clues to be traced. Thus, it became rather obvious that the disease is caused by environmental factors (though it may be, to some extent, genetically controlled). Among live agents, slow viruses are the only (and theoretically very attractive) possible cause of both BN and urothelial tumours, which occur frequently in BN endemic areas. Apart from occasional visualization of virus-like particles, other evidence supporting this hypothesis has been lacking. The role biological products, particularly fungal toxins, needs to be further defined. An excess of any heavy metal or radioactive substance as a cause of BN is very unlikely indeed; however, a deficiency of a bio-essential element could not be ruled out. Many epidemiological data indicate that water might be a transmitter of the agent(s). A wide range of ions and minerals have been incriminated, but up to now most of the studies have provided negative or inconclusive results. Organic compounds in well water have never been sufficiently considered. Another ignored area are unstable and, particularly, photosensitive substances. Fertilizers, pesticides, analgesics, local herbs and teas have no causal relation to BN.

The occurrence of ochratoxin A in coffee

“…The human pathology of BEN is a diffuse fibrosis subsequently leading to renal failure. A similar pathology was found in pigs following chronic toxicity studies conducted with OA (Radovanovic, 1989). In all species tested so far (pig, chicken, mouse, rat, dog) OA induced nephrotoxic effects, although the sensitivity of the different species varied (Kuiper-Goodman and Scott, 1989).…”

“…Special attention has been paid to OA since a link between OA and human Balkan endemic nephropathy (BEN) was postulated (IARC, 1993;Radovanovic, 1989). However, this link has not yet been proven.…”

Prevalence of Balkan Endemic Nephropathy Has Not Changed Since 1971 in the Kolubara Region in Serbia

“…Similar results were obtained in a crosssectional study of the village of Sopic, another seriously affected endemic village in the municipality of Lazarevac [4] . Familial clustering of cases is one of the most conspicuous features of the disease [13] .…”

The role of α2u-globulin in ochratoxin A induced renal toxicity and tumors in F344 rats

“…Human Balkan nephropathy was also attributed to OTA exposure. However, although there is a considerable amount of data regarding this disease, it is still controversial whether OTA plays a causative or only a subordinate role in the induction of the human Balkan nephropathy (Berndt and Hayes, 1979;Radovanovic, 1989Radovanovic, , 1991IARC, 1993). Laboratory studies with rodents, pigs, poultry and fish have demonstrated that the kidney is the primary organ for OTA induced toxicity (Fuchs, 1988).…”