Early detection of Balkan endemic nephropathy in Bosanska Posavina

Balkan endemic nephropathy (BEN) is a chronic tubulointersticial nephropathy that is diagnosed in a few agrarian regions of Balkan. Even tough numerous dilemmas and conflicting opinions regarding BEN etiology are encountered in literature, prevailing theory is that BEN is caused by chronic poisoning with aristolochic acid ingested by food in people with genetic predisposition to this disease. BEN is categorized as a toxic tubulointerstitial nephropathy, with clinical picture and disease progression not differing from other tubulointerstitial nephropathies, but with insidious and gradual progression to end stage renal disease. There is no specific and sensitive diagnostic biomarkers for BEN and we use epidemiological and functional diagnostic criteria. It is considered that BEN affects up to 10% of population in endemic region. According to Renal Register of Bosnia and Herzegovina, there are around 15% of BEN patients on chronic dialysis program, but no official data on the number of predialysis BEN patients, because of lack of adequate demographic data and screening or systematic examinations of the population living in the affected region since 1991. The members of the Society of nephrology, dialysis and transplantation of Bosnia and Herzegovina organized screening in two villages of Bosanska Posavina, as a part of the "Program Program of detection of chronic kidney diseases in high-risk population in Bosnia and Herzegovina", project which was approved from International Society of nephrology. In this paper we analyze preliminary results of that Program and discuss previous studies about BEN in Bosnia and Herzegovina, particularly diagnostic criteria and biomarkers of BEN.