Balkan nephropathy epidemiology

Another important and widespread fungal toxin is ochratoxin, which is also found in cereals and, to a lesser extent, in coffee and cocoa beans. The toxin Ochratoxin A is the most commonly found and is produced by the Aspergillus t5rpe of fungus. Exposure occurs in many countries in Europe and affects farm animals as well as humans. The major toxic effect in both humans and animals is kidney damage and cancer of the kidney. The available epidemiological evidence indicates that the disease called Balkan nephropathy is associated with consumption of food contaminated with ochratoxin, and the toxin has been detected in the blood of people living... 

The most elaborate and, seemingly consistent, hypotheses regarding etiology initially came from proponents of heredify as an explanation of fhe disease occurrence. These authors assumed that the risk of developing the disease was restricted only to specific, ethnically distinct, population groups, irrespectively of their place of birth and residence history. Wider acceptance of these hypotheses was hampered by the different perception of descriptive epidemiology of Balkan nephropathy by a majority of researchers on the topic. 

Genetic factors may play a role in different individual risk of developing Balkan nephropathy, upper urothelial tumors, both diseases or none of them [68]. However, epidemiological data indicate that one or more external, environmental factors are crucial for the occurrence of both Balkan nephropathy and excessive frequency of these tumors in endemic areas. 

Nastac E, Stoian M, Hozoc M, losipenco M, Melencu M. Further data on the prevalence of serum antibodies to papova viruses (BKand SV40) in subjects from the Romanian area with Balkan endemic nephropathy. Rev. Roum. Med.-Virol. 1984 35(1) 65-7. Radovanovic Z. Epidemiological evidence on Balkan nephropathy as a viral disease. Medical Hypotheses 1987 22 171-5. 

The diagnosis of Balkan nephropathy is now established according to epidemiological criteria suggested by Danilovic (criteria 1-3) [99], presence of tubular proteinuria and ruling out other renal diseases. 

Radovanovic Z. Epidemiological evidence on Balkan nephropathy as a viral disease. Medical Hypotheses 1987 22 171-175. 

Bukvic D, Marie I, Arsenovic A, Jankovic S, Djukanovic Lj.The prevalence of Balkan endemic nephropathy has not changed since 1971 In the Kolubara region In Serbia. Kidney Blood Press Res 2007 30 117-123 Petkovic S. Epidemiology and treatment of renal pelvic and ureeral tumours. J Urol 1971 114 858. 

The earlier literature on the association between human exposure to ochratoxin A and the occurrence of Balkan endemic nephropathy and associated urinary tract tumours was summarized in the previous evaluation (Annex 1, reference 153. Contrary to the clear causal evidence of ochratoxin A-induced nephrotoxicity and kidney carcinogenicity in rodents, the significance of ochratoxin A for human health remains unclear from the available epidemiological evidence. Moreover, ochratoxin A exposure is only one of several hypotheses concerning an environmental etiology for Balkan endemic nephropathy. 

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