engleski

Endemic nephropathy

Endemic nephropathy is a fatal kidney disease in humans, recognized as a specific entity, affecting rural population in the circumscribed areas of several European countries. EN was first recognized in the fifties, but there is evidence that this disease was present in the past as well. The disease is of a strict endemic character and so far althogether 10 endemic regions have been identified with about 100 villages. The disease exclusively affects farmers and occurs within certain families. Only people living more than 10 years in an endemic region are affected by EN. Affecting the population in the most productive age, i.e. those aged 30-50 years, the disease causes a number of medical, social and economic problems. These problems become even more obvious considering that at least 20 000 person are either suffering from or are suspected of having EN. The total number of people at risk has been estimated to approximately 100 000. The disease begins without an acute episode and progresses very slowly. After the development of non-specific signs and symptoms, typical manifestations of kidney impairment occur. Clinical characteristics have been described elsewhere. Involvment of primary tubules is characterized by a decreased tubular transport and manifestated by proteinuria. As a rule, proteinuria is very mild and accompanied by characteristic presence of low molecular weight proteins. A major pathological characteristic of EN observed on autopsy is end-stage renal fibrosis. THe kidneys are of an extremely small size (50 grams), actually the smallest kidneys described in pathology. Tha pathomorphology and histopathology of EN have been described in detail elsewhere. A very important epidemiological observation is the high inicidence of urothelial tumours in the population from the endemic area. In EN areas, the incidence of these usually rare tumours is nearly 100-fold compared to that in non-endemic areas. Kidney impairment and the high incidence of urothelial tumours, frequently observed together, appear to suggest that both EN and tumours may be caused by the same aetiological agent.

endemic nephropathy, ochratoxin A, kidney

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