Balkan nephropathy anemia

Anemia has been noted in pahents with Balkan nephropathy in early studies [18] and described as normocyhc and normochromic or mildly hypochromic [88]. It has been suggested that anemia occurs earlier in the course of the disease progression than is the case in other renal diseases and that it precedes azotemia [88, 106]. However, recent studies have failed to substanh-ate this claim [98,107]. Also, there is no evidence that anemia in Balkan nephropathy differs from anemia accompanying other renal diseases in either features [107] or rate of deteiiorahon in the progression of renal failure [108]. Nevertheless, anemia in Balkan nephropathy patients treated with hemodialysis is more severe than in patients with other renal diseases [108]. 

The most commonly used criteria for the diagnosis of Balkan nephropathy are those proposed by Danilovic et al [99]. They include (1) farmers in the endemic villages, (2) familial history positive for endemic nephropathy, (3) mild proteinuria, (3) low specific gravity of the urine, (4) anemia, early occurrence, normochromic or hypochromic, (5) retention of nitrous compounds in the blood (urea > 50 mg/dl, creatinine > 1.5 mg/dl), (6) symmetrically shrunken kidneys. Using these criteria, Danilovic classified patients into the following groups ... 

So far, laboratory studies have failed to detect any disorder as a specific marker for early detection of the disease or a reliable indicator for differential diagnosis. Laboratory studies have confirmed that Balkan nephropathy is a tubulointerstitial disease so that tubular disorders precede impairment of glomerular filtration. Although anemia is one of the criteria for the diagnosis of the disease, it has not been evidenced that pathogenesis and features of this anemia differ from that observed in other chronic renal diseases. It is only more severe in end-stage Balkan nephropathy patients than in patients with other kidney diseases. 

Pavlovic-Kentera V, Clemons G K,Trbojevic S, Dimkovic N, Djukanovic Lj. Erythropoietin and anemia in the progression of Balkan endemic nephropathy and other renal diseases. Nephron 1990 54 139-143. 

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