What is Balkan nephropathy (endemic nephropathy)?
As the name implies, this disease is particularly endemic in the so-called Balkan states or the former Yugoslavia, plus Bulgaria and Romania.
No specific etiologic cause has yet been identified, but as a result of its specific geographic distribution, environmental factors have long been suspect. Genetic and immune-related factors have also been identified.
Balkan nephropathy is a slow yet progressive form of chronic tubulointerstitial nephritis that eventually leads to ESKD.
There is a strong link between dietary consumption of aristolochic acid (see previous discussion above on Chinese herb nephropathy) with this disease and its attendant risk of uroepithelial cancer. Interestingly, aristolactam-DNA adducts were identified in kidney and urothelial tissues of affected patients.
Clinically, a characteristic early feature is that of normochromic normocytic anemia, which is disproportionate to the stage of CKD. Urinalysis usually shows mild proteinuria with few RBCs and WBCs. Patients tend to be normotensive in the earlier stages of the disease, with eventual progression to hypertension toward more advanced stages.
