Endemic nephropathy

Autori iznose podatke o rezultatima dosadašnjih ispitivanja endemske nefropatije („nefropatije balkanskih zemalja“) jugoslavenskih, bugarskih, rumunjskih i drugih istraživača. Osvrću se na historijat, geografsku rasprostranjenost, učestalost i ističu epidemiološke značajke ove endemske bolesti. Razmatraju etiološke hipoteze, analizirajući potanje suvremene postavke o mogućim etiološkim faktorima. Navode obdukcijske i bioptičke pato-morfološke nalaze, ističući nađene razlike između nalaza pojedinih skupina istraživača. Osvrću se na kliničku sliku, teškoće u dijagnostici i dosadašnje rezultate u razradi i provjeri dijagnostičkih metoda koje doprinose dijagnozi dokazivanjem tubularnog tipa proteinurije. Kritički razmatraju pojedine rezultate i postavke, iznoseći svoje stavove koji rezultiraju iz vlastitih iskustava. U zaključku ističu socijalno-medicinske aspekte problema endemske nefropatije i zalažu se za potrebu intenzivnijeg planskog, usklađenog rada na istraživanju, koje bi omogućilo djelotvorne preventivne mjere.The results of studies of endemic nephropathy (Balkan Nephropathy) obtained by Yugoslav, Bulgarian, Roumanian and other authors are reviewed. The history of the disease, its geographical distribution and frequency are dealt with and epidemiological significance pointed out. Hypotheses concerning the etiology of the disease are considered and current assumptions about possible etiological factors are analyzed in detail. Pathological findings obtained by autopsy and biopsy are presented and differences in findings of various groups of authors discussed. The clinical picture of the disease, difficulties encountered in diagnosis and current results in the development and checking up of diagnostic methods for the detection of the tubular type of proteinuria are also described. Certain results and assumptions arc critically evaluated and commented upon from the point of view of own experience. In conclusion, socio-medical aspects of the problem of endemic nephropathy are presented and the necessity for intense, well planned and coordinated research which would result in efficient preventive measures is emphasized

Morbidity and mortality from endemic nephropathy in the village of Kaniža

Izneseni su rezultati jednogodišnjeg kontinuiranog kliničko-laboratorijskog praćenja populacije jednog endemskog sela u Brodskoj Posavini. Primijenjen način rada omogućuje egzaktnije određivanje stope morbiditeta a posebice mortaliteta. Tako je utvrđeno da je u selu Kaniži u toku 1974. godine od endemske nefropatije bolovala 7,3% ljudi, da je 4,3% sumnjivo na endemsku nefropatiju i da je 1,4% umrlo od tog uzroka. U dobnim skupinama starijih od 40 godina broj oboljelih raste geometrijskom progresijom. Žene obolijevaju nešto češće od muškaraca. Nema značajnih razlika u obolijevanju između autohtonog stanovništva i imigranata.A one-year study of endemic nephropathy was carried out in the village of Kaniža in the Posavina region near Slavonski Brod. The methods used in the study and the results obtained are presented in this paper. The study included the entire population of the selected village at risk. Four criteria important for the setting up of an accurate diagnosis were used: proteinuria, ereatinemia anemia and family history of endemic nephropathy. The most important criterion - proteinuria was determined by two methods: the sulphsalicylic test and an immunodiffusion test for beta, - microglobulins. These tests were performed once a month throughout the observation time (12 months). This allowed a safer distinction between real, pathognomonic and occasional or accidental albuminurias. To obtain as exact a mortality rate as possible the cause of each death was medically scrutinized, which is not an ordinary practice. In 1974 7.3% of the Kaniža population was affected by endemic nephropathy and 4.3% was found suspect. These percentages are inversely proportional to those recorded in previous observations. The number of cases in the age group of above 40 rises at a nearly geometric progression. Endemic nephropathy was the cause of death in 1.4% of the population which is a several times higher percentage than usually reported. Women are affected more often than men (8.5% and 6.0% respectively). This is in agreement with previous observations. At first sight the autochtonous population appears to be more susceptible to endemic nephropathy than immigrants (8.3% against 5.8%). However, if the autochtonous population aged over 20 is compared with immigrants who lived at Kaniža for over 20 years - this being an approximate minimal length of exposure to the hypothetical causative agents or the latent phase of the disease - there is in fact no difference (12% against 14%)

Određivanje aflatoksina, okratoksina A, fumonizina i zearalenona u žitaricama i krmivu primjenom kompetetivnoga direktnog imunoenzimatskog testa (CD-ELISA) i tankoslojne kromatografije (TLC)

Aspergillus, Penicillium, and Fusarium species frequently contaminate crops. For this reason mycotoxins such as afl atoxins (AFs), ochratoxin A (OTA), fumonisins (FBs), and zearalenone (ZEA) are found in food and feed in a wide range of concentrations, depending on environmental and storage conditions. Consumption of mycotoxin-contaminated food and feed has been associated with acute and chronic poisoning and carcinoma. The aim of this study was to determine the incidence and co-occurrence of AFs (B1+B2+G1+G2), OTA, FBs (B1+B2+B3), and ZEA in 37 samples of cereals and feed randomly collected in 2007 from households of an endemic nephropathy (EN) area in Croatia. The mycotoxins were determined using the competitive direct ELISA test (CD-ELISA) in combination with thin-layer chromatography (TLC). The most frequent mycotoxin was ZEA (92 %, mean 318.3 μg kg-1), followed by FBs (27 %, 3690 μg kg-1), AFs (24.3 %, 4.6 μg kg-1), and OTA (16.2 %, 9.8 μg kg-1). Levels of AFs, ZEA, and FBs detected by CD-ELISA signifi cantly correlated with the TLC results. However, only one OTA-positive sample was confi rmed by TLC due to its high limit of detection. The levels of these mycotoxins were below the permissible limit for animal feed. Twenty-nine percent of cereals were contaminated with FBs, OTA, or ZEA in mass fractions above the permissible limit for humans. Co-occurrence of two toxins varied between 4.2 % and 54 % and of three between 4.2 % and 7.6 %. Prolonged co-exposure to AFs, OTA, FBs, and ZEA might increase the risk of various chronic diseases.Vrste plijesni iz rodova Aspergillus, Penicillium i Fusarium česti su kontaminanti usjeva te na takvim supstratima tvore mikotoksine. Stoga su žitarice i krmiva često kontaminirana afl atoksinima (AFs), okratoksinom A (OTA), fumonizinima (FBs) i zearalenonom (ZEA) u različitim koncentracijama ovisno o mikroklimatskim uvjetima na polju i u skladištu. Konzumiranje hrane kontaminirane mikotoksinima često je povezano s akutnim ili kroničnim trovanjima, ali i s razvojem karcinoma. Cilj ovog rada bio je odrediti istodobnu pojavnost AFs (B1+B2+G1+G2), OTA, FBs (B1+B2+B3) i ZEA u uzorcima žitarica i krme (N=37) koji su nasumično skupljeni u individualnim domaćinstvima na području endemske nefropatije (EN) u Hrvatskoj (2007). Za određivanje navedenih mikotoksina korišten je kompetitivni direktni ELISA-test (CD-ELISA) u kombinaciji s tankoslojnom kromatografi jom (TLC). Najzastupljeniji mikotoksin bio je ZEA (92 %, srednja koncentracija 318.3 μg kg-1), nakon čega slijede FBs (27 %, 3690 μg kg-1), AFs (24.3 %, 4.6 μg kg-1) te OTA (16.2 %, 9.8 μg kg-1). Koncentracije AFs, FBs i ZEA određene CD-ELISA-testom statistički značajno koreliraju s rezultatima dobivenim s TLC. OTA je potvrđen metodom TLC samo u jednom uzorku zbog visokog limita detekcije. Dokazane koncentracije su ispod razina dopuštenih za krmiva, dok je 29 % uzoraka žitarica sadržavalo FBs, OTA ili ZEA u koncentracijama iznad dopuštenih u hrani za ljude. Kokontaminacija s dvama odnosno trima toksinima varirala je između 4.2 % i 54 % odnosno između 4.2 % i 7.6 %. Dugotrajni unos AFs, OTA, FBs i ZEA putem hrane može povećati rizik od razvoja različitih kroničnih bolesti zbog njihova mogućega sinergističkog djelovanja

Okratoksin A i omjer sfinganina i sfingozina u urinu stanovnika s područja endemske nefropatije u Hrvatskoj

The most plausible theory of the aetiology of endemic nephropathy links it with exposure to nephrotoxic mycotoxin ochratoxin A (OTA). In this study, the concentration of OTA and sphinganine/sphingosine (Sa/So) ratio, the biomarker of another nephrotoxic mycotoxin fumonisin B1 exposure, were analysed in 45 human urine samples collected in the endemic village of Kaniža in Croatia and in 18 samples from control village. Samples were collected twice from the same persons in 2000 and 2005. In both years the frequency of OTA-positive samples was higher in Kaniža (43 % and 18 %, respectively) than in the control village (28 % and 6 %, respectively). OTA concentrations in samples collected in Kaniža were higher in 2000 than in 2005 (p1 at the same time, while in Kaniža four such samples were collected in 2000 and one in 2005.Najprihvatljivija teorija o etiologiji endemske nefropatije povezuje njezin nastanak s izloženošću nefrotoksičnim mikotoksinima. Dok se izloženost mikotoksinu okratoksinu A (OTA) može dokazati njegovim nalazom u biološkim uzorcima kao što su krv i urin, vrlo kratko zadržavanje fumonizina B1 (FB1) u organizmu to onemogućava. Na pokusnim je životinjama nađeno da je porast omjera koncentracija sfi ngolipida sfi nganina i sfi ngozina (Sa/So) biološki pokazatelj izloženosti tom mikotoksinu. U ovom istraživanju mjerena je koncentracija OTA i omjer koncentracija Sa/So u urinu 45 stanovnika u endemskom selu Kaniža i 18 stanovnika u kontrolnom selu. Uzorci urina skupljeni su od istih osoba 2000. i 2005. godine. U obje godine učestalost uzoraka koji su sadržavali OTA bila je veća u Kaniži (43 % i 18 %) negoli u kontrolnom selu (28 % i 6 %). Koncentracija OTA također je bila viša u urinima skupljenim u Kaniži negoli u kontrolnom selu. Koncentracija OTA u uzorcima skupljenim u Kaniži 2000. bila je viša nego u uzorcima iz 2005. (p<0.005). Iako je u urinima iz obje godine omjer koncentracija Sa/So bio viši u Kaniži negoli u kontrolnom selu, razlika nije bila statistički značajna. Nije nađen nijedan uzorak skupljen u kontrolnom selu koji bi istodobno sadržavao mjerljivu koncentraciju OTA i omjer Sa/So veći od jedan. Za razliku od uzoraka iz kontrolnog sela, četiri uzorka skupljena u Kaniži u 2000. godini i jedan uzorak u 2005. godini upućivali su na istodobnu izloženost ovim mikotoksinima

Endemic nephropathy

Autori iznose podatke o rezultatima dosadašnjih ispitivanja endemske nefropatije („nefropatije balkanskih zemalja“) jugoslavenskih, bugarskih, rumunjskih i drugih istraživača. Osvrću se na historijat, geografsku rasprostranjenost, učestalost i ističu epidemiološke značajke ove endemske bolesti. Razmatraju etiološke hipoteze, analizirajući potanje suvremene postavke o mogućim etiološkim faktorima. Navode obdukcijske i bioptičke pato-morfološke nalaze, ističući nađene razlike između nalaza pojedinih skupina istraživača. Osvrću se na kliničku sliku, teškoće u dijagnostici i dosadašnje rezultate u razradi i provjeri dijagnostičkih metoda koje doprinose dijagnozi dokazivanjem tubularnog tipa proteinurije. Kritički razmatraju pojedine rezultate i postavke, iznoseći svoje stavove koji rezultiraju iz vlastitih iskustava. U zaključku ističu socijalno-medicinske aspekte problema endemske nefropatije i zalažu se za potrebu intenzivnijeg planskog, usklađenog rada na istraživanju, koje bi omogućilo djelotvorne preventivne mjere.The results of studies of endemic nephropathy (Balkan Nephropathy) obtained by Yugoslav, Bulgarian, Roumanian and other authors are reviewed. The history of the disease, its geographical distribution and frequency are dealt with and epidemiological significance pointed out. Hypotheses concerning the etiology of the disease are considered and current assumptions about possible etiological factors are analyzed in detail. Pathological findings obtained by autopsy and biopsy are presented and differences in findings of various groups of authors discussed. The clinical picture of the disease, difficulties encountered in diagnosis and current results in the development and checking up of diagnostic methods for the detection of the tubular type of proteinuria are also described. Certain results and assumptions arc critically evaluated and commented upon from the point of view of own experience. In conclusion, socio-medical aspects of the problem of endemic nephropathy are presented and the necessity for intense, well planned and coordinated research which would result in efficient preventive measures is emphasized

Characteristics of Proteinuria in Endemic Nephropathy

Peer Reviewe