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

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

Trends in Renal Replacement Therapy in Bosnia and Herzegovina 2002-2008

Renal Registry (RR) of Bosnia and Herzegovina was established in 2002, with aim to follow up the trends of Renal Replacement Therapy in Bosnia and Herzegovina. The prevalence of Renal Replacement Therapy (RRT) in Bosnia and Herzegovina is rising steadily. One reason for this is an increasing number of patients starting RRT. The aim is to present the epidemiology and treatment of all aspects of RRT in Bosnia and Herzegovina in period 2002-2008. Centre-related and patient-related questionnaires were sent to all 25 dialysis centres in Bosnia and Herzegovina. The demographic data, prevalence and incidence, type of renal replacement therapy, cause of ESRD, erythropoietin administration, cause of death, and type of vascular access were obtained from the questionnaires. Collected data were analysed using SPSS statistics. The number of patients treated by Renal Replacement Therapy (RRT) increased steadily from 1,531 patients in 2002 to the 2,206 at the 2008 (43%). The prevalence has increased from 399 pmp in 2002 to 696 pmp. in 2008. Incidence (new patients) in 2002 was 110 pmp and incidence rate in 2008 was 163, and there were 249 new patients (day 1). The mean age for new patients increased from 60 years in 2002 to 63.5 years in 2008 and the population over 75 years rate from 8.79% to 11.3%. Most ESRD patients in Bosnia and Herzegovina are undergoing intermittent hemodialysis (92%), while some patients (8%) are treated by peritoneal dialysis and transplantation. The most significant cause of ESRD in 2008 was chronic glomerulonephritis (421 patients, 19.2%), followed by pyelonephritis (414 patients, 18.9%), BEN (14.7%) and Diabetes mellitus (12.2%). Hepatitis B and C virus infections had 397 (16.3%) patients, out of them 22 had both type of infections and 98 patients had B type infection. Only 10.5% of patients were tested on MRSA and 3 patients were positive on MRSA. There were no HIV-positive patients on RRT. The most common type of vascular access was AV fistula in 85% patients, AV graft 2% and catheters in 13%. Out of hemodialysis patients, 85.7% received ESA almost s.c. The median weekly dose was 4,000 UI. Cardiovascular diseases were the leading cause of death, gross mortality rate of dialysis patients being 13.01% in 2008. The need for RRT in Bosnia and Herzegovina is increasing and the number of patients increased by 43% since 2002. Hemodialysis is still the most common modality of treatment (92%), while proportion of PD and transplantation is slowly increasing. The preventive measures are necessary to prevent ESRD and also to decrease the number of patients on dialysis

Glomerular Filtration Rate in Examined Population of Bosnian Posavina - Region of Balkan Endemic Nephropathy

Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular filtration rate (GFR), is assumed a marker of overall renal function. The aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region Study included 603 inhabitants of Bosnian Posavina, out of whom 386 (65%) from endemic (Domaljevac) and 217 (36%) from non-endemic (Svilaj) village, and it was performed in two phases. The first phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specific gravity, pH, proteins, leukocytes, glucose, ketones, and mycroalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (5 th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (603), 145 examinees were included in the second phase. After exclusion of 17 diabetic patients, 94 (73%) examinees from endemic and 34 (27%) examinees from non-endemic region remained. In the endemic region there were 46 (49%) examinees with and 48 (51%) without family burden for BEN. Overall GFR in examined groups was within physiologic range. There was not statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN (Mann-Whitney test p=0.104; Fisher’s test p=1), neither between examinees with and without family burden for BEN within endemic region (Mann-Whitney test p=0’7393; Fisher’s test p=0,263). Overall GFR in examined groups was within physiologic range. There wasn’t statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN, neither between examinees with and without family burden for BEN within endemic region. GFR, no matter how accurately calculated and estimated, does not represent significant biomarker for diagnosis, especially early diagnosis, of BEN, until maybe its overt advanced form

Glomerular Filtration Rate in Examined Population of Bosnian Posavina - Region of Balkan Endemic Nephropathy

Balkan endemic nephropathy (BEN) is chronic tubulointersticial nephritis of unknown aetiology characterized by an insidious onset and gradual progression to end stage renal disease (ESRD). Endemic regions of Bosnia and Herzegovina are Posavina and Semberija, sited at basin of Sava River. In BEN, just like in other chronic renal diseases (CKD), glomerular filtration rate (GFR), is assumed a marker of overall renal function. The aim of this study was to compare GFR in examinees of endemic and non-endemic region for BEN, and between examinees with and without risk factors for BEN within endemic region Study included 603 inhabitants of Bosnian Posavina, out of whom 386 (65%) from endemic (Domaljevac) and 217 (36%) from non-endemic (Svilaj) village, and it was performed in two phases. The first phase encompassed obtaining anamnestic data (demographic, personal and family history), measurement of arterial blood pressure, and urine dipstick testing (specific gravity, pH, proteins, leukocytes, glucose, ketones, and mycroalbuminuria). In the second phase, besides repeated urine dipstick test, laboratory blood testing and abdominal ultrasound, with special attention to urinary tract, was also performed. We have compared GFR between examinees of endemic and non-endemic regions for BEN, and between examinees with and without family burden for BEN within endemic region, using MDRD formula for calculating GFR, with cut-off value (5 th percentile) based on result of studies performed in European Caucasians in screening for CKD and for establishing stages of CKD in BEN. Medical was used for statistical testing. Out of total number of examined inhabitants (603), 145 examinees were included in the second phase. After exclusion of 17 diabetic patients, 94 (73%) examinees from endemic and 34 (27%) examinees from non-endemic region remained. In the endemic region there were 46 (49%) examinees with and 48 (51%) without family burden for BEN. Overall GFR in examined groups was within physiologic range. There was not statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN (Mann-Whitney test p=0.104; Fisher’s test p=1), neither between examinees with and without family burden for BEN within endemic region (Mann-Whitney test p=0’7393; Fisher’s test p=0,263). Overall GFR in examined groups was within physiologic range. There wasn’t statistically significant difference in calculated GFR between examinees of endemic and non-endemic regions for BEN, neither between examinees with and without family burden for BEN within endemic region. GFR, no matter how accurately calculated and estimated, does not represent significant biomarker for diagnosis, especially early diagnosis, of BEN, until maybe its overt advanced form

Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla [version 1; referees: 2 approved]

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016.   Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis