Limitations and plausibility of the Pliocene lignite hypothesis in explaining the etiology of Balkan endemic nephropathy.
BACKGROUND
Balkan endemic nephropathy (BEN) is a chronic, tubulointerstitial renal disease often accompanied by urothelial cancer that has a lethality of nearly 100%.


BACKGROUND
One of the many factors that have been proposed to play an etiological role in BEN is exposure to organic compounds from Pliocene lignite coal deposits via the drinking water in endemic areas.


OBJECTIVE
The objective of this study was to systematically evaluate the role of the tenets of the Pliocene lignite hypothesis in the etiology of BEN in order to provide an improved understanding of the hypothesis for colleagues and patients alike.


METHODS
A comprehensive compilation of the possible limitations of the hypothesis, with each limitation addressed in turn is presented.


RESULTS
The Pliocene lignite hypothesis can best account for, is consistent with, or has the potential to explain the evidence associated with the myriad of factors related to BEN.


CONCLUSIONS
Residents of endemic areas are exposed to complex mixtures containing hundreds of organic compounds at varying doses and their potentially more toxic (including nephrotoxic) and/or carcinogenic metabolites; however, a multifactorial etiology of BEN appears most likely.
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Maharaj
D001449:Balkan Nephropathy / Q000139:chemically induced* / Q000453:epidemiology; D063368:Balkan Peninsula / Q000453:epidemiology; D003031:Coal / Q000032:analysis / Q000633:toxicity*; D060766:Drinking Water / Q000032:analysis; D004781:Environmental Exposure; D004784:Environmental Monitoring; D006801:Humans; D015994:Incidence; D015995:Prevalence; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*
D003031:Coal; D060766:Drinking Water; D014874:Water Pollutants, Chemical