Balkan (Endemic) Nephropathy

Limitations and plausibility of the Pliocene lignite hypothesis in explaining the etiology of Balkan endemic nephropathy

“…For example, a positive correlation between the amount of rainfall and the number of BEN deaths over the following 2 years has been shown as significant (r50.80). 7 Though this supports a fungal hypothesis for the cause of BEN due to increased growth of fungi and toxin production from damp autumnal conditions, 7 it is also consistent with the Pliocene lignite hypothesis. Drinking water in endemic areas is largely influenced by rain, as average depth-to-water of open shallow wells and springs is 0-10 m in Romania 33 and ,15 m in Bulgaria.…”

“…7,87 However, the disease also occurs in mountainous districts in Bulgaria 1 that are as high as 600 m in altitude, 83 and therefore, is not consistent with frequent flooding, and indeed there is no correlation between altitude and BEN frequency in Bulgaria. 87 Rainfall, however, may impact BEN progression.…”

“…For example, differences in fluorescence excitation/emission matrix spectra between drinking water samples from BEN and non-BEN households within the endemic village of Brestovac in the former Yugoslavia were due to higher organic compound concentrations in samples from BEN households. 29 However, more research is needed, including well-by-well evaluations to Provided a spouse has lived with an affected family for 15 or more years, the risk of contracting the disease is as high as it is for the indigenous occupants of a house, 7 suggesting the cause is not due primarily to genetic factors, 4 but to an environmental one.…”

“…5 Transplantation is usually not an option, 6 and typically 50% of patients have died within 2 years of diagnosis. 7 Of the many hypotheses that have been proposed for the etiology of BEN, [8][9][10][11][12][13][14][15][16][17][18] evidence from many studies favors the involvement of an environmental factor(s) in the etiology of the disease, 1,[19][20][21][22][23][24][25][26] for example, exposure to organic compounds from Pliocene lignite coal deposits. The Pliocene lignite hypothesis posits that BEN is caused by long-term exposure to low concentrations of toxic organic compounds leaching into drinking water, that is used almost exclusively by the population, via groundwater from Pliocene lignites found in the vicinity of endemic settlements.…”

Ochratoxin A and Aristolochic Acid Involvement in Nephropathies and Associated Urothelial Tract Tumours

“…These promote biotransformation of OTA into quinone derivatives, which are responsible for a specifi c OTA covalent DNA adduct, C-C8dG OTA, recently identifi ed by ms/ms (66). The correlation between OTA intake and the levels of OTA derivatives in the urine of on Serbian people and complete absence of AA (18,59) or its derivatives corroborate the association between OTA and not AA and EN.…”