Consensus statement on screening, diagnosis, classification and treatment of endemic (Balkan) nephropathy.

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.

Higher apoptotic cell rate in Balkan endemic nephropathy--stereologic analysis.

The aim of this study was to correlate apoptotic cell rate from different nephron segments between control group and groups of patients with Balkan endemic nephropathy (BEN). Kidney specimens of20 patients with clinically and epidemiologically confirmed BEN were compared with biopsy material of 10 patients (group I, non BEN) without glomerular or tubulointerstitial disease. Out of 20 patients with BEN, 10 suffered and died from BEN (group II, BEN) and 10 patients (group III, BEN/CV) suffered from BEN but died from cardiovascular disease. Patient age ranged from 40 to 50 years. The apoptotic cell rate was measured in proximal and distal tubules and in collecting ducts using the 40X objective with a calibrated eyepiece multipurpose M 42 test system according to Weibel. Comparison of all three nephron segments yielded statistically significant differences in volume density of apoptotic cells in proximal tubules and in collecting ducts among all three patient groups (non BEN vs. BEN, non BEN vs. BEN/CV and BEN vs. BEN/CV, P<0.001 all). Statistically significant difference in apoptotic cell rate was also found in distal tubules between non BEN and BEN groups and non BEN and BEN/CV groups, but not between BEN and BEN/CV groups. Our results showed a statistically significant increase of apoptotic cells in all three nephron segments in patients with BEN (BEN and BEN/CV) compared to control group. The highest number of apoptotic cells was found in distal tubules in the groups of patients with BEN and BEN with coexisting cardiovascular disease, suggesting that these cells might be most frequently and most severely injured in patients with BEN.

Comparison of occurrence of upper urinary tract carcinomas in the region with endemic villages and non-endemic nephropathy region in Croatia.

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial renal disease of a still unknown etiology, associated with an increased frequency of urothelial carcinoma, particularly of the upper urinary tract (UUT). The aim of the study was to compare the occurrence of UUT carcinomas between Brodsko-Posavska Region (BPR) which is the region with endemic villages and the non-endemic region of Zagreb (ZG) in two six-year periods with a 20 year period separating the two, pointing out a possible difference in occurrence regarding war in Croatia (1991-1995). Comparing BPR and ZG regions we found a more then 5 times higher frequency of UUT carcinomas in BPR in the first period and more than 4.5 times higher frequency in the second period. Women in BPR were more frequently affected with UUT carcinomas.