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Balkan Endemic Nephropathy - Causes, Symptoms, Diagnosis, Risk Factors, and Treatment

Published on Nov 09, 2022 and last reviewed on Nov 28, 2022   -  4 min read

Abstract

Balkan endemic nephropathy is a chronic renal disease caused by the inflammation of interstitial cells of the kidney. Read the article to know more about it.

What Is Balkan Endemic Nephropathy?

Balkan endemic nephropathy is a type of chronic renal disease generally found in Bosnia, Bulgaria, Croatia, Romania, and Serbia. This is a unique type of disease found in the people of eastern Europe with a high prevalence of renal disease with slow progression and a certain loss of kidney function. It is found to be caused by a certain class of phytotoxins called aristolochic acid.

Earlier it was found that genetic factors and certain environmental factors like heavy metals, fungal toxins, and polycyclic aromatic hydrocarbons were responsible for the disease. The main reason behind nephropathy is the aristolochic acid, which is released from the decaying Aristolochia clematitis weed. This acid was found to contaminate the soil and food crops in the affected region. Aristo Lokea plants and their extracts were used as herbal medicine for diseases such as gout, arthritis, and inflammation. Aristolochic acid is found to have high nephrotoxicity and carcinogenicity.

How Is Balkan Endemic Nephropathy Caused?

  • The Balkan endemic nephropathy is found in the people of eastern Europe. The reason behind this was found to be the aristolochic acid secreted by the Aristolochia clematitis weed. Dietary exposure to aristolochic acid is the cause of Balkan nephropathy.

  • When the Aristolochia clematitis weed decays, the aristolochic acid is released into the cultivation soil. These acidic particles are present in the soil or taken up by the neighboring food crops through their roots. These acidic particles then get deposited into the grains and, when consumed by the people, cause Balkan endemic nephropathy. These acidic particles also reach the nearby wells and rivers, contaminating the water and becoming a source of aristolochic acid. When this acid gets deposited in the human body, it causes damage and inflammation to the interstitial cells of the kidney causing nephrotoxicity. This process is a slow and chronic progression of the disease which finally leads to renal failure.

  • The Balkan endemic nephropathy has a multifactorial etiology which includes genetic predisposition, presence of contaminants, and environmental pollutants.

  • The various exogenic and endogenic factors includes-lead intoxication, a change in the enzyme activity, genetic polymorphism, viral disease, immunological factors, metal, and metalloids.

What Are the Symptoms of Balkan Endemic Nephropathy?

The disease progresses very slowly, and its symptoms often remain and are unrecognized for years. The early sign and symptoms may include-

  • Weakness.

  • Pain in the lumbar region.

  • The pallor of the skin.

  • Brownish discoloration of the palms and soles- xanthochromia.

In the advanced stages, the symptoms include-

  • Anemia (decrease in the red blood cell count).

  • Inflammation of the interstitial cells causes deranged renal function.

  • Hematuria (presence of blood in urine).

  • Decrease in the glomerular filtration rate GFR.

  • Family in history of the disease.

Balkan nephropathy cannot be reversed and finally leads to end-stage renal disease.

These patients are distinguished from other patients with renal disease by the absence of high blood pressure and absence of proteinuria. When the mother is diagnosed with nephropathy, The offspring are found to have characterized short kidneys and increased excretion of albumin, total protein, and beta2 microglobulin.

What Are the Risk Factors Associated With Balkan Endemic Nephropathy?

  • Transitional Cell Carcinoma of the Upper Urothelial Tract - Balkan nephropathy is associated with an increased rate of transitional cell carcinoma of the upper urothelial tract. The urothelial cells are the cells found in the bladder, renal pelvis, ureters, and urethra. It is the most commonly occurring urinary bladder cancer. Transitional cell carcinoma is also called urothelial carcinoma.

  • End-Stage Renal Disease - Inflammation of the interstitial cells of the kidney leads to impairment in the kidney which finally leads to end-stage renal disease, which cannot be reversed and can be treated by only transplantation of the kidney or dialysis.

How to Diagnose Balkan Endemic Nephropathy?

  • Kidney Ultrasound - The imaging technique kidney ultrasound reveals a decrease in the size of kidneys and small contracted kidneys in the end-stage.

  • Blood and Urine Tests - Confirms the presence of blood in urine, increased level of creatinine and blood, increased level of albumin in urine, total protein, beta2 microglobulin in the urine of a newborn whose mother has been diagnosed with Balkans nephropathy.

  • Kidney Biopsy - It is done in cases where it is needed to identify which part of the tissues has been affected.

How to Treat Balkan Endemic Nephropathy?

There are no specific ways to treat nephropathy; the final stage of it leads to end-stage renal disease, which can only be treated by dialysis and kidney transplant.

  • Dialysis - It is the procedure in which the blood is purified using a machine outside the body. This purified blood is there again transferred to the human body and thus can be made free of waste products. Dialysis is an inconvenient procedure since the patient needs to be hospitalized every time, and it should be done at regular intervals of time.

  • Kidney Transplant - A kidney transplant is a procedure in which a kidney from a donor is transplanted inside the human body. This is a better option for patients suffering from end-stage renal disease and having to go to dialysis regularly. The transplanted kidney purifies the blood and performs the rest of its functions as the normal kidney.

  • Preventive Measures - Diagnosis should be made based on the kidney ultrasound results, which can determine the presence of nephropathy. Various steps need to be taken in order to prevent exposure to contaminants. The cultivation of Aristolochia clematitis should be banned in the areas of food-cultivating plants and water resources. Further research is to be done on the presence of Aristolochic acid in water resources like rivers and wells.

Conclusion :

Nephropathy is a slow progression of the disease and can be stopped when diagnosed earlier. This disease is an endemic disease that is restricted to certain populations in eastern Europe. The people in the affected areas should take great care of the contamination of the food concerning aristolochic acid. These people in the affected areas should take a sample verification of the soil before cultivation. The water source for drinking water should also be verified as pure and then should be given for drinking in the mass population.

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Last reviewed at:
28 Nov 2022  -  4 min read

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