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PubMedDate not supplied

Studies on the familial character of endemic Balkan nephropathy. Possible role of the toxic hydric factor in the determination of "familial agglomerations" in endemic Balkan nephropathy.

The study was carried out in an attempt to explain the familial character of endemic Balkan nephropathy and of agglomeration of cases in certain households and in the ascendency of certain families. The hypotheses of a genetic disease or that of an infectious etiology have been taken into consideration in previous studies - by chromosomal analyses and statistical-mathematic tests of contagiousness - without being able to find arguments in support of one or the other hypotheses. This study brings important elements in favour of the possible role of ecologic factors and mainly of the hydrictoxic one, in the determination of the familial agglomerations in endemic nephropathy. Thus using radionuclear determination methods, we could demonstrate in a locality of the endemic area that around the water sources with high content of nephrotoxic oligoelements (cadmium, chromium, manganese, cobalt) there are more diseased families than around water sources poorer in these oligoelements.

Balkan Nephropathy↗
PubMed2006

Differences in renal registries between the Balkans and Western Europe.

The epidemiology data of renal replacement therapy are collected by national renal registries and extended to international registries as the European Renal Association Renal Registry. The extent and accuracy of data vary widely among countries. The aim of this study was to compare combined data from the national renal registries of Balkan countries contributing the ERA-EDTA Registry or from other sources, with combined data from renal registries of the Western and Northern European Countries and regions contributing the ERA-EDTA Registry. Data regarding incident and prevalent patients in 2003, mean age of incident and prevalent patients, incidence and prevalence by cause of renal failure and prevalence by established therapy were compared between the countries of the Balkan region and the countries of Western and Northern Europe contributing to the ERA-EDTA Registry. Data were obtained by the Annual Report 2003 of the ERA-EDTA Registry, and for Romania by the study of G. Mirescu published in NDT 2004. Some data were obtained by the questionarries sent to people responsible for the national registries. The results showed the following: the incident number of patients per million population (pmp) at day 1 of RRT, as well as at day 91, adjusted for age and gender, did not statistically differ between the Balkans and Western Europe: 119.2 +/-25.1 vs. 123.3 +/- 25.9 and 110.9 +/- 34.7 vs. 106.5 +/- 18.3, respectively. The mean age of incident patients at day 91 of RRT significantly differed between the Balkans and Western Europe, 57.7 +/- 4.49 vs. 63.3 +/- 2.2, p < 0.005. The percentage of incident patients by cause of renal failure at day 91 of RRT did not significantly differ between the Balkans and Europe. The mean incidence of the percentage of DM as a cause of renal failure between the Balkans and Western Europe did not differ, 23.05+/- 4.5 vs. 20.3 +/- 7.2. When adjusted for age and gender, the significant difference in prevalent number of ESRD patients between the Balkans and Western Europe disappeared. The mean age of prevalent patients between the Balkans and Europe did not significantly differ, 54.3 +/- 4.2 vs. 58.2 +/- 2.8. The percentage of primary renal disease in prevalent patients did not significantly differ, except for policystic kidney disease which is significantly more frequent in Western Europe compared to the Balkans, 9.2 +/- 1.9 vs. 6.8 +/- 1.8, p < 0.01. Diabetes mellitus and hypertensive nephropathy are much more frequent in incident patients compared to prevalent ones. Transplantation is significantly more frequent in Western Europe, predominantly cadaveric, whereas dialysis is more frequent in the Balkans. It can be concluded that no difference exists between the incidence and prevalence of diabetes mellitus as a primary renal disease in ESRD patients between the Balkan and European countries, indicating that the epidemic of diabetes is already present in the Balkans and imposing, perhaps, efforts to be undertaken for planning prevention strategies; kidney transplantation is significantly less represented as RRT in Balkan countries compared to Western and Northern Europe, and efforts should be made for its increase, particularly the cadaveric one, and moreover, because the population on RRT is significantly younger in the Balkans.

Europe↗
PubMed1991

Beta 2-microglobulin in patients with Balkan nephropathy and in healthy members of their families.

The aim of this study was to investigate serum levels, urinary excretion and in vitro peripheral blood mononuclear cell (PBMC) production of beta 2-microglobulin in patients with Balkan nephropathy and their families. Increased urinary beta 2-microglobulin excretion was found in Balkan nephropathy, chronic pyelonephritis and glomerulonephritis patients, being highest in the first group. The serum level of beta 2-microglobulin in Balkan nephropathy patients correlated with residual kidney function. Synthesis of beta 2-microglobulin by PBMC, untreated or stimulated by PHA, was not increased in Balkan nephropathy patients or their healthy family members compared to the control group of healthy persons living outside of an endemic region. This study has shown that the increased serum beta 2-microglobulin level in Balkan nephropathy patients is the consequence of the glomerular filtration rate (GFR) reduction. Urinary beta 2-microglobulin excretion was found increased not only in patients but in some healthy members of nephropathic families. beta 2-microglobulin therefore can serve as a marker of the early tubular damage in Balkan nephropathy. However, urinary beta 2-microglobulin is not specific for Balkan nephropathy, lacking specificity required for screening purposes. The different patterns of serum and urinary beta 2-microglobulin, and other urinary proteins, in patients with Balkan nephropathy from patients with chronic pyelonephritis and glomerulonephritis favor the opinion that Balkan nephropathy is a separate clinical entity.

Albuminuria↗
PubMed1991

Urinary tract tumors and Balkan nephropathy in the South Morava River basin.

The aim of this investigation was to study the frequency of urinary tract tumors (UTT) in settlements around the South Morava River and its tributaries where Balkan nephropathy is endemic. For this purpose 659 surgery and autopsy records of patients with UTT were reviewed. The records came from 25 counties and 1279 settlements classified as endemic, hypoendemic and nonendemic. Upper tract urothelial, urinary bladder and kidney tumors were included in the evaluation. A highly significant geographic correlation between Balkan nephropathy and UTT localized in renal pelvis and ureter was noted in the South Morava River valley. These tumors were 57 and 61.8 times more frequent in endemic settlements than in control rural and city populations free of Balkan nephropathy. The frequency of urinary bladder tumors in endemic settlements was also increased compared with the nonendemic villages and large cities, up to 11.9 and 8.5 times, respectively. In endemic settlements, upper urinary tract tumors were five times and tumors of urinary bladder were seven times more frequent in families with Balkan nephropathy than in those without, and up to 224 times more frequent than in the city families. Familial clustering of UTT was also noted. The geographic correlation between Balkan nephropathy and UTT supports the speculation that these disorders share a common etiology.

Aged↗
PubMed2004

Alu insertion polymorphisms in the Balkans and the origins of the Aromuns.

We have analysed 11 human-specific Alu insertion polymorphisms in the Balkans to elucidate the origins of the Aromuns, a linguistic isolate inhabiting scattered areas in the Balkan Peninsula. Four Aromun samples (two from the Republic of Macedonia, one from Albania, and one from Romania) and five neighbouring populations (Macedonians, Albanians, Romanians, Greeks, and Turks) were analysed by means of genetic distances, principal components and analyses of the molecular variance (AMOVA). Three hypotheses were tested: Aromuns are Romanophonic Greeks; the result of a Romanian southward migration; or local descendants of the Thracians. The analyses show that the Aromuns do not constitute a homogeneous group separated from the rest of the Balkan populations. Grouping by language or geography does not explain the genetic differences observed in the region, suggesting a lack of genetic structure in the area. Aromuns do not seem to be particularly related to Greeks, Romanians, or to other Romance speakers. The Aromuns might have their origin to the south of the Danube river, with extensive gene flow with the neighbouring populations. The present results suggest a common ancestry of all Balkan populations, including Aromuns, with a lack of correlation between genetic differentiation and language or ethnicity, stressing that no major migration barriers have existed in the making of the complex Balkan human puzzle.

Alu Elements↗
PubMed1993

Urinary glycosaminoglycans in different phases of Balkan endemic nephropathy.

The relationship between glycosaminoglycans and beta 2-microglobulin, glycosaminoglycans and N-acetyl-beta-D-glucosaminidase as well as the relationship between the chondroitin sulfate/heparan sulfate ratio and SDS electrophoresis in the urine of subjects from the endemic area of Balkan nephropathy was studied in order to establish a method for early detection of this disease. The results show an unquestionable increase in urinary excretion of total glycosaminoglycans in subjects with or suspected of having Balkan endemic nephropathy while the chondroitin sulfate/heparan sulfate ratio was not statistically different between the groups studied. Thus, the chondroitin sulfate/heparan sulfate ratio cannot be used as a cheap and quick semiquantitative method for the diagnosis of early tubular damage in Balkan endemic nephropathy. However, the determination of total glycosaminoglycans in the urine of subjects from endemic areas proved to be valuable additional information helping with the diagnosis of Balkan endemic nephropathy.

Acetylglucosaminidase↗
PubMed1999

[Comparison of upper urinary tract tumors in the region of Balkan nephropathy with those of other regions of Yugoslavia].

OBJECTIVES: To compare the epidemiological and histological characteristics of upper urinary tract tumours in the region of Balkan endemic nephropathy with those of urothelial tumours observed in other regions. MATERIAL AND METHODS: From 1970 to 1997, 766 patients were treated in the Belgrade Department of Urology for an upper urinary tract tumour. These patients were derived from 3 regions: the region of Balkan endemic nephropathy (BEN), the region of probable Balkan endemic nephropathy (PBEN) and the region without Balkan endemic nephropathy (WBEN). The incidence of tumours in BEN + PBEN patients was 68% versus 32% for WBEN patients. The histological and epidemiological characteristics of the tumours in these three groups were compared. RESULTS: Tumours were more frequent in women in the BEN and PBEN groups (1.2:1 and 1.1:1) than in the WBEN group (0.6:1). The tumour was diagnosed an average of 5 years later in the first 2 groups than in the WBEN group (p < 0.05). The BEN and PBEN groups presented a higher incidence of renal failure (45% and 35%), but especially a much higher incidence of bilateral tumours (13% and 6%) than in the WBEN region (2%). CONCLUSION: Our analysis shows that upper urinary tract tumours depend on geographical factors: the incidence of these tumours is significantly higher in regions of BEN and PBEN, women are more frequently affected, tumours are associated with a high incidence of renal failure, bilateral tumours are more frequent, and tumours are more frequent in older patients. Comparison of the histological and pathological characteristics of the tumours did not reveal any significant difference between these three regions.

Age Factors↗
PubMed1991

Some pathomorphological features of Balkan endemic nephropathy in Croatia.

Over the last 16 years, 214 autopsies were done at the Department of Pathology and Forensic Medicine, Slavonski Brod Medical Centre, on people from an area recognized as endemic for Balkan nephropathy in the county. Balkan endemic nephropathy was diagnosed pathoanatomically and histopathologically in 94 of these cases, and in none of 1040 autopsies on people from a nonendemic area. The most striking pathological finding in all advanced cases of the disease was a marked reduction in kidney size and weight; in one extreme case, the organ weighed only 20 g. The process is invariably bilateral, but there are considerable differences in the degree of involvement in each pair. Although the pathoanatomical changes, including lung oedema and haemorrhage and fibrinous pericarditis, are seen in the majority of cases, they are not considered to be specific for Balkan endemic nephropathy, since they are well recognized signs of long-standing primary uraemia. The relevance of the peculiar finding of sulfurous yellow discoloration and hardened subcutaneous adipose tissue, seen frequently post mortem, is unknown and should be investigated in more detail. Histopathologically, fibrosis and atrophy of kidney cortex, with tubular degeneration, are the most consistent findings. Lesions characteristic of pyelonephritis were superimposed over the picture of 'pure' Balkan endemic nephropathy in a considerable number of cases.

Adipose Tissue↗
PubMed2005

Genetic characterization of the M RNA segment of a Balkan Crimean-Congo hemorrhagic fever virus strain.

Crimean-Congo hemorrhagic fever (CCHF) virus causes one of the most severe diseases in humans, with a mortality rate of up to 30%. It is transmitted to humans by the bite of hard ticks or by contact with blood or tissues from human patients or infected livestock. Balkan Peninsula is an endemic region of the disease, and sporadic cases or even outbreaks are observed every year. The M RNA segment encodes for the glycoprotein precursor of two surface glycoproteins Gn and Gc. Up to now complete M RNA CCHF virus sequences have been published from strains isolated in Nigeria, China, Pakistan, Tajikistan, and Russia. In the present study, the genetic characterization of the complete nucleotide sequence of the M RNA segment of a Balkan CCHF virus strain, Kosovo/9553/2001, isolated in summer of 2001 from a human fatal case in Kosovo is reported. This is the first published complete M nucleotide sequence of a CCHF virus strain isolated in Balkans. It was found that the Balkan strain is similar to the Russian strain, both strains differing from all other completely sequenced CCHF virus strains by approximately 22% at the nucleotide level forming an independent clade in the phylogenetic tree.

DNA, Complementary↗