Balkan nephropathy refers to a degenerative interstitial nephropathy endemic to the Balkan states, which is associated with a very high rate of transitional cell carcinomas of the renal pelvis and upper ureter.
The condition is largely restricted to the villages along the Danube river and it's tributaries in Bosnia–Herzegovina, Bulgaria, Croatia, Romania and Serbia. It typically occurs in 2-5% of individuals after 15 year of living in the area and is believed to be due to ingestion of aristolochic acid (AA) in seeds of the Aristolochia clematitis plant 2.
The same condition has also been reported as Chinese herbs nephropathy when aristolochic acid containing extracts were inadvertently added to slimming tables in Brussels in 1990 2-3.
There are presumably genetic reasons to explain why only a minority of patients living in endemic areas and consuming toxic levels of aristolochic acid develop the nephropathy and associated upper urinary tract transitional cell carcinomas.
Transitional cell carcinomas in these patients are typically multiple and low grade, located within the renal pelvis or upper ureter 1. Findings are similar to sporadic TCCs (thus please refer to TCC of the renal pelvis, and TCC of the ureter for further discussion).
Treatment and prognosis
As these tumors are bilateral, multiple and of low grade conservative management is the mainstay of treatment 1.
- 1. Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol. 2009;192 (6): 1488-93. doi:10.2214/AJR.09.2577 [pubmed citation]
- 2. de Jonge H, Vanrenterghem Y. Aristolochic acid: the common culprit of Chinese herbs nephropathy and Balkan endemic nephropathy. Nephrol. Dial. Transplant. 2008;23 (1): 39-41. doi:10.1093/ndt/gfm667 [pubmed citation]
- 3. Vanherweghem JL, Depierreux M, Tielemans C et-al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet. 1993;341 (8842): 387-91. [pubmed citation]