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EVALUATION of ARISTOLOCHOLIC ACID and LIGNITE HYPOTHESES on the ETIOLOGY of BALKAN ENDEMIC NEPHROPATHY

Year 2023, , 562 - 572, 03.06.2023

Ayça Doğrul Selver

https://doi.org/10.17780/ksujes.1212546

Abstract

Balkan Endemic Nephropathy (BEN) is a chronic kidney disease defined in the Balkans in the 1950s. When it was observed that the distribution of Pliocene coal beds and the areas with BEN was the same in Balkan countries, the lignite hypothesis was proposed for the etiology of BEN. This hypothesis proposes that groundwater washes the lignites and absorbs toxic organic substances which results in developing BEN if this water is used. Studies revealed the weaknesses of lignite hypothesis, and showed that exposure to Aristolocholic Acid and Ochratoxin (AA and OTA) may play a role in the etiology of BEN.

The absence of kidney disorders in other countries with Pliocene lignites is the most important finding that weakens the lignite hypothesis. Similarly, the etiology of BEN could not be explained by exposure to AA and OTA alone. The main weaknesses of single-factor etiology are: Not all residents living in BEN-endemic areas develop BEN; not all family members in a household with BEN develop BEN, and women are prone to develop BEN. In conclusion, multifactorial etiology is effective in the development of BEN. In this study, studies examining the relationship between BEN and the lignite and aristolocholic acid hypotheses were compiled.

Keywords

Balkan Endemic Nephrophaty lignite beds poliaromatic hydrocarbons aristolocholic acid

References

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BALKAN ENDEMİK NEFROPATİSİ ETİYOLOJİSİNDE ARİSTOLOKOLİK ASİT ve LİNYİT HİPOTEZLERİNİN DEĞERLENDİRİLMESİ

Year 2023, , 562 - 572, 03.06.2023

Ayça Doğrul Selver

https://doi.org/10.17780/ksujes.1212546

Abstract

Balkan Endemik Nefropatisi (BEN), Balkanlar’da 1950’li yıllarda tanımlanmış, kronik bir böbrek rahatsızlığıdır. Bulgaristan, Romanya ve Sırbistan gibi ülkelerde Pliyosen yaşlı kömür yataklarının ve BEN’li alanların yayılımının aynı olması sebebiyle BEN etiyolojisi için linyit etkisi öne sürülmüştür. Bu hipotez, kömür ile ilişkili olan yeraltı suyunun linyitleri yıkayarak yapılarındaki toksik organik maddeleri bünyesine aldığını, bu suyun arıtılmadan kullanılmasıyla BEN geliştiğini önerir. Sonraki çalışmalar, bu hipotezin zayıf yanlarını ortaya çıkarırken, nefrotoksik/kanserojenik bazı toksinlere (Aristolokolik Asit ve Okratoksin; AA ve OTA) çeşitli yollarla maruz kalınmasının BEN etiyolojisinde önemli rol oynadığını ortaya çıkarmıştır.
Linyit hipotezini zayıflatan en önemli bulgu, Pliyosen linyit yataklarının bulunduğu diğer ülkelerde benzer böbrek rahatsızlıklarının görülmemesidir. Benzer şekilde, BEN etiyolojisi sadece AA ve OTA’ya maruz kalmakla da açıklanamamıştır. Tek faktörlü etiyolojiyi zayıflatan en temel noktalar şunlardır: BEN-endemik bölgelerde yaşayan tüm bölge sakinlerinin hastalanmaması, BEN hastası olan bir evdeki tüm aile bireylerinin hastalanmaması ve kadınların erkeklere oranla daha fazla hastalanması.
Sonuç olarak, yaygın olarak kabul edilen görüş, BEN gelişiminde çok faktörlü etiyolojinin etkin olduğudur. Çok temel olarak, linyit kaynaklı PAH’ların veya fenollerin, antropojenik kökenli fitalatların ve AA’nın toksik etkilerinin birleşmesi ve genetik yatkınlık gibi sebeplerle hastalığın geliştiği kabul edilmektedir. Bu çalışmada, BEN hastalığı ile linyit ve aristolokolik asit arasındaki ilişkinin incelendiği çalışmalar derlenmiştir.

Keywords

Balkan endemik nefropatisi linyit yatakları poliaromatik hidrokarbonlar aristolokolik asit.

References

  • Bui-Klimke, T. R. & Wu, F. (2015). Ochratoxin A and Human Health Risk: A Review of the Evidence. Critical Reviews in Food Science and Nutrition, 55(13), 1860–1869. https://doi.org/10.1080/10408398.2012.724480.
  • Cancer, I. A. for R. on. (1993). Some naturally occurring substances: Food items and consti- tuents, heterocyclic aromatic amines and mycotoxins. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon.
  • Chan, W., Pavlović, N. M., Li, W., Chan, C., Liu, J., Deng, K., Wang, Y., Milosavljević, B. & Kostić, E.N. (2016). Quantitation of Aristolochic Acids in Corn, Wheat Grain, and Soil Samples Collected in Serbia: Identifying a Novel Exposure Pathway in the Etiology of Balkan Endemic Nephropathy. Journal of Agricultural and Food Chemistry, 64(29), 5928–5934. https://doi.org/10.1021/acs.jafc.6b02203
  • Chandrajith, R., Nanayakkara, S., Itai, K., Aturaliya, T. N. C., Dissanayake, C. B., Abeysekera, T., Harada, K., Watanabe, T. & Koizumi, A. (2011). Chronic kidney diseases of uncertain etiology (CKDue) in Sri Lanka: geographic distribution and environmental implications. Environmental geochemistry and health, 33(3), 267–278. https://doi.org/10.1007/s10653-010-9339-1
  • Chernozemsky, I. N., Stoyanov, I. S., Petkova-Bocharova, T. K., Nicolov, I. G., Draganov, I. V, Stoichev, I. I.,Tanchev, Y., Naidenov, D. & Kalcheva, N. D. (1977). Geographic correlation between the occurrence of endemic nephropathy and urinary tract tumours in vratza district, Bulgaria. International Journal of Cancer, 19(1), 1–11. https://doi.org/10.1002/ijc.2910190102
  • Craciun, E. C. & Rosculescu, I. (1970). On Danubian endemic familial nephropathy (Balkan nephropathy): Some problems. The American Journal of Medicine, 49(6), 774–779. https://doi.org/10.1016/S0002-9343(70)80058-4
  • Davidson, R. M. (1982). Molecular Structure of Coal. M. L. Gorbaty, J. W. Larsen &I. B. T.-C. S. WENDER (Ed.), (ss. 83–160). London: Academic Press. https://doi.org/https://doi.org/10.1016/B978-0-12-150701-5.50009-7
  • Doğrul Selver, A. & Uras, Y. (2022a). Investigation of Organic and Inorganic Contaminants in Water Sources around Elbistan Lignite Beds. Gazi University Journal of Science Part A: Engineering and Innovation, 9(3), 347–358. https://doi.org/10.54287/gujsa.1152444
  • Doğrul Selver, A. & Uras, Y. (2022b). Organıc And Inorganıc Contamınants In Water Sources Around Elbıstan Basın. In 2nd International Symposium on Advanced Engineering Technologies (pp. 41)
  • EFSA. (2006). Opinion of the Scientific Panel on Contaminants in the Food Chain on a request from the Commission related to ochratoxin A in food,. The EFSA Journal (C. 365).
  • EFSA Panel on Contaminants in the Food Chain. (2010). Statement on recent scientific information on the toxicity of Ochratoxin A. EFSA Journal (C. 8). https://doi.org/10.2903/j.efsa.2010.1626
  • Feder, G., Radovanovic, Z. & Finkelman, R. B. (1991). Relationship between weathered coal deposits and the etiology of Balkan endemic nephropathy. Kidney International, 40, S9–S11. Ganguli, A. (2016). Uddanam Nephropathy/Regional Nephropathy in India: Preliminary Findings and a Plea for Further Research. American journal of kidney diseases. United States. https://doi.org/10.1053/j.ajkd.2016.04.012
  • Gluhovschi, G., Modalca, M., Mǎrgineanu, F., Velciov, S., Gluhovschi, C., Bob, F.,Petrica,L., Bozdog, G., Trandafirescu, v. & Gǎdǎlean, F. (2011). Epidemiological data regarding Balkan endemic nephropathy in relationship with the Pliocene coal etiological hypothesis. Romanian journal of internal medicine: Revue roumaine de médecine interne, 49(1), 11–24.
  • Grollman, A. P. & Jelakovic, B. (2007). Role of Environmental Toxins in Endemic (Balkan) Nephropathy. Journal of the American Society of Nephrology, 18(11), 2817–2823. https://doi.org/10.1681/ASN.2007050537
  • Grosse, Y., Baan, R., Straif, K., Secretan, B., El Ghissassi, F., Bouvard, V., Benbrahim-Tallaa, L., Guha, N., Galichet, L. & Cogliano, V. (2009). A review of human carcinogens-Part A: pharmaceuticals. The lancet oncology, 10(1), 13–14. https://doi.org/10.1016/s1470-2045(08)70286-9
  • Hranjec, T., Kovaè, A., Kos, J., Mao, W., J., J. C., Grollman, A. P. & Jelakovic, B. (2005). Endemic Nephropathy: the Case for Chronic Poisoning by Aristolochia. Crotian Medical Journal, 46(1), 116–125.
  • Iordanidis, A., Schwarzbauer, J., Georgakopoulos, A. & van Lagen, B. (2012). Organic geochemistry of Amynteo lignite deposit, northern Greece: A Multi-analytical approach. Geochemistry International, 50(2), 159–178. https://doi.org/10.1134/S0016702912020036
  • Ivić, M. (1969). Etiology of endemic nephropathy. Lijecnicki Vjesnik, 91(12), 1273–1281.
  • Karmaus, W., Dimitrov, P., Simeonov, V., Tsolova, S., Bonev, A. & Georgieva, R. (2008). Metals and kidney markers in adult offspring of endemic nephropathy patients and controls: A two-year follow-up study. Environmental Health: A Global Access Science Source, 7. https://doi.org/10.1186/1476-069X-7-11
  • Kosateva, A. D., Stefanova, M., Marinov, S., Czech, J., Carleer, R. & Yperman, J. (2017). Characterization of organic components in leachables from Bulgarian lignites by spectroscopy, chromatography and reductive pyrolysis. International Journal of Coal Geology, 183(June), 100–109. https://doi.org/10.1016/j.coal.2017.10.005
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Details

Primary Language Turkish
Subjects Geological Sciences and Engineering (Other)
Journal Section Reviews
Authors

Ayça Doğrul Selver 0000-0002-9003-5439

Publication Date June 3, 2023
Submission Date November 30, 2022
Published in Issue Year 2023

Cite

APA Doğrul Selver, A. (2023). BALKAN ENDEMİK NEFROPATİSİ ETİYOLOJİSİNDE ARİSTOLOKOLİK ASİT ve LİNYİT HİPOTEZLERİNİN DEĞERLENDİRİLMESİ. Kahramanmaraş Sütçü İmam Üniversitesi Mühendislik Bilimleri Dergisi, 26(2), 562-572. https://doi.org/10.17780/ksujes.1212546