Diagnostic Criteria for Balkan Endemic Nephropathy: Proposal by an International Panel

Stefanović, Vladisav; Jelaković, Bojan; Čukuranović, Rade; Bukvić, D; Nikolić, Jovan; Lukić, Ljiljana; Gluhovschi, G.; Toncheva, Draga; Polenakovič, Momir; Cosyns, Jean‐Pierre

doi:10.1080/08860220701600732

Cited by 37 publications

(44 citation statements)

References 19 publications

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“…Recently, criteria proposed by an international panel are published, and the work on criteria continues. [9] A basic strategy of a descriptive epidemiological work would be to find out what all endemic regions have in common, what distinguishes them from the nonendemic settlements, and healthy persons living in and out of endemic settlements.…”

Section: Descriptive Epidemiologymentioning

confidence: 99%

Fifty Years of Balkan Endemic Nephropathy: Challenges of Study Using Epidemiological Method

et al. 2009

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Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease associated with urothelial cancer, which affects people living in the alluvial plains along the tributaries of the Danube River. Challenges of studying BEN using the epidemiological method are multiple. The natural history from exposure to occurrence of the disease may take many years. The early stages of BEN are not easily detectable clinically, as the disease is asymptomatic until a significant decline in function occurs, and even then symptoms are usually non-specific. The natural history of BEN is complex, possibly with multiple risk factors operating both at the stage of initiation of renal damage and in its progression. In BEN, genetic susceptibility is due to multiple genes of small effects, gene-gene interactions, and gene-environment interactions of complex nature that are difficult to assess with current study designs. BEN is now kidney disease of the old people, and many risk factors for disease such as smoking, alcohol consumption, obesity, and diabetes could contribute to the kidney damage. Evidence is presented that environmental rather than genetic factors play a decisive role in the etiopathogenesis of BEN. Aristolochic acid, described as a culprit of BEN in 1959, is confirmed in 2007 by the molecular biology methods. Mycotoxins and polycyclic aromatic hydrocarbons, leached from lignites and found in the vicinity of endemic settlements, deserve further investigation. Despite advances in understanding the epidemiology of BEN, more research is needed on the patterns of BEN over time and between places, and on identifying the contributions of modifiable risk factors in initiating and hastening progression of BEN in order to improve the scope for preventing BEN. Primary prevention is still at the beginning. Knowledge accumulated in the fifty years of BEN research and new data about prevention and treatment of chronic kidney disease reveal several effective methods in secondary and tertiary prevention of BEN. Genetic epidemiology could establish the relative size of the genetic effect in relation to other sources of variation in disease risk (i.e., environmental effects such as intrauterine environment, physical and chemical effects, as well as behavioral and social aspects). Public health authorities in the several countries having aristolochic acid nephropathy should take immediate measures for reducing dietary exposure of residents to Aristolochia.

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Section: Descriptive Epidemiologymentioning

confidence: 99%

Fifty Years of Balkan Endemic Nephropathy: Challenges of Study Using Epidemiological Method

et al. 2009

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“…As diagnostic criteria we used those proposed by Danilovic 10 supplemented with alpha1-microglobulinuria according to the results of our previous study and the proposal by an international panel. 18,19 All 12 patients with positive family history for kidney disease had proteinuria and/or alpha1-microglobulinuria. In addition to these findings one patient had impaired eGFR and two had impaired GFR, anemia, and reduced kidney length, i.e., almost all criteria for BEN diagnosis.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of kidney disease in two rural communities in Kosovo and Metohia

Stašević¹,

Gorgieva²,

Vasić³

et al. 2010

Renal Failure

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A systematic survey was carried out in an enclave in Kosovo and Metohia, with the aim of assessing the prevalence of kidney diseases. The survey involved 423 (180 males) adult inhabitants from two small settlements, Velika Ho0a and Orahovac, and included an interview, medical documentation, physical, ultrasound, and laboratory examinations. Persons with any detected disorder indicating kidney disease were invited for additional examination of kidney function. Using urine dipstick test, proteinuria was detected in 19.1% and hemoglobinuria in 4.5% of the examined subjects. Glomerular filtration rate (Modification of Diet in Renal Disease (MDRD) formula) below 60 mL/min/1.73 m 2 was found in 5.2% of subjects. Kidney ultrasound examination detected reduced length of right and left kidneys in 38 and 24 persons, respectively. Cysts were also a frequent finding, but polycystic kidney, hydronephrosis, and kidney stones were found in about 2% each.

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“…Učestalost patološkog nalaz u urinu kod članova porodica opterećenih endemskom nefropatijom u zavisnosti od prisutnih faktora rizika zultate pregleda stanovnika pojedinih endemskih sela, najčešće se navode samo rezultati o broju bolesnika sa EN, a nema podataka o drugim otkrivenim bolestima bubrega. U nedavno objavljenim radovima o dijagnostičkim kriterijumima za EN ističe se značaj diferencijalne dijagnoze EN i drugih bolesti bubrega, a posebno nefroangioskleroze koja se kao i EN najčešće javlja kod starijih osoba, protiče asimptomatski i praćena je pojavom malobrojnih i nespecifičnih biomarkera [18,19]. Činjenica da su hipertenzija i dijabetes danas masovne hronične bolesti, donosi i novi dijagnostički problem razlikovanja EN od dijabetesne i hipertenzivne nefropatije kod osoba iz porodica opterećenih EN.…”

Section: Diskusijaunclassified

“…Ovi podaci ukazuju da je u daljem dijagnostičkom postupku neophodno da se utvrdi tačna dijagnoza bolesti, odnosno da se u diferencijalnoj *p<0,05 dijagnozi razmatra EN, nefroangioskleroza, kao posljedica hipertenzije ili starosti i dijabetesna nefropatija, ali i ishemijska bolest bubrega i druge bolesti bubrega. Radovi koji su posvećni dijagnostičkim kriterijumima za EN ističu da ne postoji specifičan biomarker za EN i da se dijagnoza može postaviti samo kombinacijom nekoliko biomarkera i epidemioloških kriterijuma [1,18,19]. Rezultati ovog rada ukazuju da visoka učestalost hipertenzije, sve češći dijabetes i veliki broj starih osoba među članovima EN porodica, čine problem diferencijalne dijagnoze početnih stadijuma EN još težim.…”

Section: Diskusijaunclassified

BIOMEDICINSKA ISTRAŽIVANJA 2011; 2(1):27-32 UDK: 616.61-008.64-036.21 Originalni rad Da li su opravdani sistematski pregledi stanovnika u žarištima endemske nefropatije?

Ристић¹,

Марић

Лукић³

et al. 2011

Biomedicinska istraž.

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Kratak sadržajUvod. U endemskim selima Donje i Gornje Crnjelovo urađeni su sistematski pregledi odraslih stanovnika u proljeće 2009. i 2010. godine. Analiza rezultata prikazana u ovom radu urađena je sa ciljem da se utvrdi učestalost faktora rizika za nastanak bolesti bubrega i učestalost osoba sa markerima bolesti bubrega u zavisnosti od prisutnih faktora rizika.Metod. Skriningom je obuhvaćeno 1216 osoba, 554 muškog pola, starosti 51,9 ± 17,1 godina. Ispitivanje se sastojalo od ankete, mjerenja krvnog pritiska i pregleda urina test trakom kojom se određuje prisustvo proteina, krvi, leukocita i glukoze.Rezultati. Kod 53% ispitanih osoba otkriven je bar jedan od četiri faktora rizika za hroničnu bolest bubrega: 36% ispitanika je bilo starije od 60 godina, 34% je imalo hipertenziju, 17% pozitivnu porodičnu anamnezu o endemskoj nefropatiji (EN), a 10% dijabetes. Proteinurija je otkrivena kod 68 (5,6%) ispitanika, hematurija kod 111 (9,1%), leukociturija kod 220 (18,1%), a glikozurija kod 38 (3,1%). Učestalost proteinurije i/ili hematurije, kao dva glavna markera bolesti bubrega, varirala je u zavisnosti od prisutnih faktora rizika. Kod osoba sa pozitivnom porodičnom anamnezom za EN bila je 10,2%, kod bolesnika sa hipertenzijom 15,6%, sa dijabetesom 12%, a kod onih koji su bili preko 60 godina 29,4%. Mnogi od ispitanika su imali više od jednog faktora rizika, što je uzrokovalo i učestaliju pojavu patološkog nalaza u urinu.Zaključak. Zbog visoke prevalence faktora rizika za hroničnu bolest bubrega u žarištima EN, neophodno je da se redovno sprovode studije skrininga. Tokom ispitivanja otkrivenih bolesnika, posebnu pažnju bi trebalo posvetiti diferencijalnoj dijagnozi između endemske, hipertenzivne i dijabetesne nefropatije. Traganje za pouzdanim biomarkerima za diferencijalnu dijagnozu ovih hroničnih bolesti bubrega je jedan od važnih zadataka daljih istraživanja.Ključne riječi: hronična bolest bubrega, faktori rizika, žarišta endemske nefropatije

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Diagnostic Criteria for Balkan Endemic Nephropathy: Proposal by an International Panel

Cited by 37 publications

References 19 publications

Fifty Years of Balkan Endemic Nephropathy: Challenges of Study Using Epidemiological Method

Fifty Years of Balkan Endemic Nephropathy: Challenges of Study Using Epidemiological Method

High prevalence of kidney disease in two rural communities in Kosovo and Metohia

BIOMEDICINSKA ISTRAŽIVANJA 2011; 2(1):27-32 UDK: 616.61-008.64-036.21 Originalni rad Da li su opravdani sistematski pregledi stanovnika u žarištima endemske nefropatije?

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