Naslov
DIAGNOSIS OF ENDEMIC (BALKAN) NEPHROPATHY - CROATIAN EXPERIENCE EPIDEMIOLOGIC ELEMENTS IN NEW CRITERIA OF EN

Autori
Miletić-Medved, Marica ; Jelaković, Bojan

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Acta Medica Croatica / Kes, Petar - Zagreb : Akademija medicinskih znanosti Hrvatske, 2008, 99-99

Skup
ENDEMIC NEPHROPATHY International Workshop on Diagnostic Criteria

Mjesto i datum
Bol, Hrvatska, 17.04.2008. - 18.04.2008

Vrsta sudjelovanja
Plenarno

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Endemic nephropathy; Croatia; prevalence EN; Ca pyelonis; Ca ureteris; Diagnosis

Sažetak
Endemic (Balkan) nephropathy (EN) is chronic tubulointerstitial nephritis. In Croatia, endemic area is located in western part of the Slavonski Brod County, on the left bank of the river Sava. It is flood plain of the river Sava 93 meters above sea level, alluvial ground, with the population of approximately 10.000 inhabitants living in 14 villages. As EN frequently affects particular families i.e. households and has perfidious onset and chronic course, it has become a serious public health, social and economic problem in endemic region. Observations and conclusions from epidemiological studies were the key elements in making conclusion that EN is caused by an environmental agents that is nephrotoxic and carcinogenic. Well known characteristics of EN that support this statement are: a) Focal occurrence of chronic kidney disease (CKD) in the valleys of big tributaries of the Danube river ; b) Occurrence of the disease in the rural population only ; c) Person has to live for at least 15 years in the endemic area ; d) It affects the members of the same household (blood and non blood related) ; e) Both immigrants in endemic region and emigrants are affected ; f) High prevalence of upper urinary tract transitional cell (urothelial) cancer (UUC). EN has long subclinical phase when kidney damage is only manifested with proximal tubule damage. It is very important to make diagnosis in this early phase because of secondary prevention of CKD. Apart this, those persons should be closely monitored due to very high risk of UUC. Screening of the whole EN villages (perlustracija) has a long tradition in Croatia. We have conducted epidemiologic field examinations of EN population during last three decades with the intention of making early diagnosis of CKD and UUC and to observe oscillation in prevalence of both entities in our EN area. First perlustracija in Croatia was performed in 1957 in the villages of Bebrina, Slavonski Kobaš and Pričac. In the following years all EN villages were included in this program. The EN population is under medical control, which allows particular epidemiological variables to be studied. During the field examinations, inhabitants signed informed consent which is followed by filling detailed questionnaire, clinical examination, blood drawing and urine sampling. Ultrasound examination of the upper abdomen and kidneys is also part of our surveys. Inhabitants of EN villages are classified according to the slightly changed WHO criteria into four groups: 1. Diseased of EN &#8211; a) tubular proteinuria (in the past we used &#946; 2, and in last 10 years we introduced &#945; 1- microglobulinuria as a marker of proximal tubule damage (>20 mg/L or > 15 mg/g UC), b) anemia (men Hb < 120 g/L ; women Hb <113 g/L), c) serum creatinine > 132.6 &#956; mol /L, and d) positive family history ; 2.Suspect of having proteinuria = a)+b) or b)+d) ; 3. At risk of having EN &#8211; farmers without any pathologic sign but with positive family history, or member of the EN households ; 4. &#8220; The others"- inhabitants of EN village without positive family history and pathologic signs. In last several years we became aware that current diagnostic criteria are obsolete and imprecise. This could influence calculations of prevalence of EN, but could be misleading in making diagnosis in particular person. False positive results will increase unnecessary costs and will be burden to medical providers, but false negative results could be fatal for each underdiagnosed subject.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita

POVEZANOST RADA