BALKAN ENDEMİK NEFROPATİSİ ETİYOLOJİSİNDE ARİSTOLOKOLİK ASİT ve LİNYİT HİPOTEZLERİNİN DEĞERLENDİRİLMESİ

Ayça Doğrul Selver

doi:10.17780/ksujes.1212546

EN TR

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

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 ENDEMİK NEFROPATİSİ ETİYOLOJİSİNDE ARİSTOLOKOLİK ASİT ve LİNYİT HİPOTEZLERİNİN DEĞERLENDİRİLMESİ

Öz

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.

Anahtar Kelimeler

Kaynakça

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Ayrıntılar

Birincil Dil

Türkçe

Konular

Yer Bilimleri ve Jeoloji Mühendisliği (Diğer)

Bölüm

Derleme

Yazarlar

Ayça Doğrul Selver ^*
0000-0002-9003-5439
Türkiye

Yayımlanma Tarihi

3 Haziran 2023

Gönderilme Tarihi

30 Kasım 2022

Kabul Tarihi

23 Ocak 2023

Yayımlandığı Sayı

Yıl 1970 Cilt: 26 Sayı: 2

DOI

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

IZ

https://izlik.org/JA27SN92CJ

Kaynak Göster

RIS / Bibtex

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