engleski

IMMIGRANT STATUS IN A BALKAN AREA OF ENDEMIC NEPHROPATHY IS A NEGATIVE PREDICTOR FOR PROXIMAL TUBULE DAMAGE

Introduction and Aims: Endemic nephropathy (EN) represents a form of aristolochic acid nephropathy (AAN) where AA was ingested via contaminated bread. Improvement in agriculture that took place 20-30 years ago significantly decreased contamination of flour with AA. We hypothesized that a group of immigrants from Bosnian non-EN area who settled Croatian EN area in that period, due to the lack of exposure, could not be at risk for developing EN. Methods: According to EN consensus criteria, we analysed proximal tubule damage (PTD) = α1microglobuline/creatinine (Alfa1CR)> 31.5 mg/g and renal function (CKD = eGFR <60ml/min/1.73m2) in 2 161 farming villagers who were divided into 3 groups: autochthonous inhabitants of EN (N=1687) and non-EN villages (N=372), and immigrants (N=102). Results: Diseased and suspect of having EN had higher alfa1CR values than immigrants (102vs.48vs.7.04 ; p0.05). Immigrants had significantly lower prevalence of PTD (1.3% vs.3.0%vs.8.3%) and CKD (5.9% vs. 8.9% vs.15.8%) than non-EN and EN villagers, respectively (for both p<0.001). No EN case was detected in immigrants. Immigrant status was found to be independent negative predictor of PTD (OR 0.35 ; 95%CI 0.14-0.86 ; p=0.022), unlike positive family history for EN which was strongly positive predictor (OR 2.31 ; 95%CI 1.43-3.74 ; 0.001). As we reported, 20 years ago immigrants observed significantly less A.clematitis and their seeds, and less frequently baked bread compared to EN villagers (p<0.001). Conclusions: Due to improvements in agriculture exposure to AA, an environmental toxic agent for EN is decreasing. Our result on negative predictive value of immigrant status strongly confirms this presumption. Attenuation of exposure to AA will probably lead to decrease in prevalence and subsequently disappearance of EN.

endemic nephropathy; immigrants

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