Environment, Medical Geology and the Etiology of Balkan Endemic Nephropathy

Background Balkan endemic nephropathy (BEN) is an irreversible, chronic, tubulo-interstitial nephropathy of unknown origin, geographically confined to several rural regions of the Balkan Peninsula. The first "official" observation of a disease resembling BEN was made almost six decades ago in regions comprising the former Yugoslavia (Danilovic et al., 1957). Shortly thereafter, similar descriptions came from Bulgaria and Romania (Radovanovic et al., 2000; Ceovic et al., 1992; Craciun and Rosculescu, 1970). The distribution of BEN includes regions of central and southeastern Serbia, southwestern Romania, northwestern Bulgaria, southeastern Croatia, and parts of Bosnia and Kosovo (Figure 1). The geological setting of the endemic areas in the affected countries is similar. Most of the BEN villages are located on alluvial plains of tributaries of the Danube River, with older Tertiary layers (clays, sands and Pliocene lignites) covered by Quaternary river sediments (Figure 2). It is estimated that several thousand people in the affected countries are currently suffering from BEN and that thousands more will be diagnosed with BEN in the coming years.