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Balkan nephropathy

Etiology: - environmental disease? - long-term consumption of food contaminated with aristolochic acid (a plant alkaloid endemic to the region)? Epidemiology: - affects only certain endemic rural foci along tributaries of the Danube River in the Balkan countries of Bosnia, Bulgaria, Croatia, Romania, & Serbia (southeastern Europe) - associated with Chinese herbal medications? [1] Pathology: - chronic tubulointerstitial kidney disease progressing to end-stage renal disease - frequent development of upper urinary tract tumors Clinical manifestations: - long incubation period - family history of kidney disease Laboratory: - glomerular filtration rate decreased - 24 hour urine protein < 1 g/24 hours - urinalysis: relatively benign urine sediment Special laboratory: - cystoscopy as indicated - cystoscopy with retrogade ureteropyelography [1] Radiology: - ultrasound of kidneys, ureter, bladder - CT urography Complications: - increased risk of urothelial cancers - transitional cell carcinomas of the renal pelvis, ureter, & bladder (ureteral cancer, bladder cancer)

General

tubulointerstitial nephropathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021.
  2. Bamias G, Boletis J. Balkan Nephropathy: Evolution of Our Knowledge Am J Kidney Dis. 2008 Sep;52(3):606-16. PMID: 18725017
  3. Stefanovic V, Polenakovic M Fifty years of research in Balkan endemic nephropathy: where are we now? Nephron Clin Pract. 2009;112(2):c51-6 PMID: 19390202
  4. Gokmen MR, Cosyns JP, Arlt VM et al The epidemiology, diagnosis, and management of aristolochic acid nephropathy: a narrative review. Ann Intern Med. 2013 Mar 19;158(6):469-77. Review. PMID: 23552405
  5. Stefanovic V, Toncheva D, Polenakovic M. Balkan nephropathy. Clin Nephrol. 2015;83(7 Suppl 1):64-9. Review. PMID: 25725245 Free Article
  6. Jelakovic B, Dika Z, Arlt VM et al Balkan Endemic Nephropathy and the Causative Role of Aristolochic Acid. Semin Nephrol. 2019 May;39(3):284-296 PMID: 31054628