“…6 Provided that the necessary hydrogeologic conditions for leaching and transportation of the organic compounds from the deposits to wells and springs have been met, a BENlike kidney disease may still exist unrecognized, e.g., in developed countries due to population mobility, and/or too small an area affected (such as coal stored next to a power plant 30 ), and in undeveloped areas, i.e., Burma and rural China, due to inadequacies in the medical infrastructure for correct diagnoses. 6 Furthermore, as more data becomes available, more possible links may be supported, e.g., an interstitial nephropathy similar to BEN has been described in Greece; 22 in Louisiana and Wyoming, USA, kidney disease and renal pelvic cancer may be associated with coal deposits, including lignites; 58,75 and in Texas, USA 76 and northern Portugal, 77 renal disease may also be associated with lignites. Thus, the restricted disease distribution of BEN to the Balkans may be due to the distinct organic compound composition of the regional organic-rich leachable rocks and sediment (including, of course, Pliocene lignites), which are unique with respect to petrological and organic geochemistry reflecting differences in the for instance, peat forming vegetation and paleoenvironment as a result of the limiting paleogeographic coal-forming conditions in the Tertiary swamps during the Pliocene, 27 coupled with the right hydrological, demographical, and medical infrastructure conditions.…”