Balkan nephropathy

Etiology

• environmental disease?
• long-term consumption of food contaminated with aristolochic acid (a plant alkaloid endemic to the region)?

Epidemiology

• affects only certain endemic rural foci along tributaries of the Danube River in the Balkan countries of Bosnia, Bulgaria, Croatia, Romania, & Serbia (southeastern Europe)
• associated with Chinese herbal medications?

Pathology

• chronic tubulointerstitial kidney disease progressing to end-stage renal disease
• frequent development of upper urinary tract tumors

Clinical manifestations

• long incubation period
• family history of kidney disease

Laboratory

• glomerular filtration rate decreased
• 24 hour urine protein < 1 g/24 hours
• urinalysis: relatively benign urine sediment

Diagnostic procedures

• cystoscopy as indicated
  • cystoscopy with retrogade ureteropyelography

Radiology

• ultrasound of kidneys, ureter, bladder
• CT urography

Complications

• increased risk of urothelial cancers
  • transitional cell carcinomas of the renal pelvis, ureter, & bladder (ureteral cancer, bladder cancer)

More general terms

• tubulointerstitial nephropathy