title: [Investigation of Balkan endemic nephropathy in Serbia: how to proceed?].
abstract: Balkan endemic nephropathy (BEN) presents an unsolved puzzle despite fifty years of its investigation. Academy of Medical Sciences of the Serbian Medical Society organized a round table discussion on current unsolved problems related to BEN. The present paper summarizes presentations, discussion and conclusions of this meeting. During the last fifty years, the course of BEN prolonged and it shifted towards the older age in all endemic foci. Data on the incidence of BEN have been controversial and frequently based on the data on the number of BEN patients starting haemodialysis treatment. In Serbia, BEN patients present 6.5% of haemodialysis population and this percentage differs among different centres ranging from 5% (Leskovac) to 46% (Lazarevac). Maintenance of high prevalence of BEN patients on regular haemodialysis indicates that BEN is not an expiring disease. In addition, recent data have shown more frequent microalbuminuria and low-molecular weight proteinuria in children from endemic than from nonendemic families. Aetiology of BEN is still unknown despite numerous investigations of environmental and genetic factors. Today, there is a very current hypothesis on the aetiological role of aristolochic acid but the role of viruses, geochemical factors and genetic factors must not be neglected. Morphological features of BEN are nonspecific and characterized by acellular interstitial fibrosis, tubular atrophy and changes on pre- and postglomerular vessels. New immunohistochemical and molecular biology methods offer a new approach to BEN investigation. Association of BEN with high incidence of upper-urothelial tumours is well-known. Recent studies have shown significant changes of demographic characteristics of patients suffering upper-urothelial tumours, their prevalence in different endemic foci and characteristics of tumours. Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.
authors.forename: Ljubica
authors.initials: L
authors.lastname: Djukanović
authors.forename: Vladisav
authors.initials: V
authors.lastname: Stefanović
authors.forename: Gordana
authors.initials: G
authors.lastname: Basta-Jovanović
authors.forename: Danica
authors.initials: D
authors.lastname: Bukvić
authors.forename: Stevan
authors.initials: S
authors.lastname: Glogova
authors.forename: Jovan
authors.initials: J
authors.lastname: Dimitrijević
authors.forename: Suncica
authors.initials: S
authors.lastname: Djurić
authors.forename: Slavenka
authors.initials: S
authors.lastname: Janković
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Lukić
authors.forename: Ivko
authors.initials: I
authors.lastname: Marić
authors.forename: Jovan
authors.initials: J
authors.lastname: Nikolić
authors.forename: Ivana
authors.initials: I
authors.lastname: Novakovic
authors.forename: Vesna
authors.initials: V
authors.lastname: Pejović
authors.forename: Snezana
authors.initials: S
authors.lastname: Radisavljević
authors.forename: Nenad
authors.initials: N
authors.lastname: Rakić
authors.forename: Vojin
authors.initials: V
authors.lastname: Savić
mesh_terms: D001449:Balkan Nephropathy / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D006435:Renal Dialysis; D055771:Serbia / Q000453:epidemiology