Familial versus environmental factors in Balkan endemic nephropathy in Mehedinti county, Romania, by means of albuminuria and tubular biomarkers: preliminary study.
OBJECTIVE
Balkan endemic nephropathy (BEN), a regional tubulointerstitial kidney disease encountered in South-Eastern Europe, with still undefined etiology and inexorable evolution towards end stage renal disease, raises the question of the relative contribution of family and environmental factors in its etiology. In order to evaluate the intervention of these factors, markers of tubular injury have been assessed, this lesion being considered an early renal involvement in BEN.


METHODS
The paper studies relatives of BEN patients currently included in dialysis programmes (for involvement of the family factor) and their neighbors (for involvement of environmental factors) and analyzes them with regard to tubular injury by means of tubular biomarkers (N-acetyl-beta-d-glucosaminidase-NAG and alpha-1-microglobulin), and albuminuria. At the same time, glomerular filtration rate (GFR) (CKD-EPI) was measured. It is considered that, in order to acquire the disease, one should have lived for 20 years in the BEN area. The relatives have been classified according to this criterion.


RESULTS
More evident tubular injury was found in the neighbors of BEN patients living for more than 20 years in the endemic area, which argues in favor of environmental factors. Higher levels of urinary alpha-1-microglobulin and albumin in relatives of BEN patients who had been living for more than 20 years in the area than in relatives with a residence under 20 years, plead for the same hypothesis. GFR was lower in persons who had been living for more than 20 years in the BEN area (neighbors and relatives).


CONCLUSIONS
Environmental factors could be more important in BEN than family factors.
Division of Nephrology, Romanian Academy of Medical Sciences, Emergency County Hospital , Timisoara , Romania .
Gheorghe
G
Gluhovschi
Mirela
M
Modilca
Silvia
S
Velciov
Cristina
C
Gluhovschi
Ligia
L
Petrica
Corina
C
Vernic
Adriana
A
Kaycsa
D000118:Acetylglucosaminidase / Q000378:metabolism*; D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology; D000510:Alpha-Globulins / Q000378:metabolism*; D001449:Balkan Nephropathy / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D004782:Environmental Health / Q000379:methods / Q000706:statistics & numerical data; D005192:Family Health / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012383:Romania / Q000453:epidemiology
D000510:Alpha-Globulins; D015415:Biomarkers; C016001:alpha-1-microglobulin; D000118:Acetylglucosaminidase
Alpha-1-microglobulin; NAG; balkan endemic nephropathy