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From history of medicine
INVESTIGATION OF ENDEMIC NEPHROPATHY IN NON-ENDEMIC RURAL SETTLEMENTS NEAR ENDEMIC NEPHROPATHY FOCI
Sveto Suša1, Radomir Raičević2, Branka Mitić2, Jovanka Zagorac3 i Jelena Cvetanović3
Centar scientific investigation SANU and University in Niš, Serbia1
Nephrology Clinic, Clinical center Niš, Niš, Serbia2
Health center Aleksinac, Aleksinac, Serbia3
An attempt of emigration from endemic foci in Bulgaria has not proved useful. Ten people who have left the endemic foci in early youth, in the third and fourth decades of life, had severe forms of renal failure. Data obtained from members of jeopardized families indicate that their close relatives had suffered and died of this disease before World War II. In the available literature, there have not been descriptions of similar characteristics of endemic nephropathy, which would pertain to other parts of the world, except for three countries: Yugoslavia, Bulgaria and Romania.
The aim of the paper was to determine whether the settlements adjacent to the endemic nephropathy foci were also affected by this disease. Secondly, to establish the uniform criteria for detecting cases in the preclinical stage.
Examinations were conducted in the rural settlements Zitkovac, Prćilovica and Donje Suhotno near the endemic focus Aleksinac Municipality. We examined 3.985 out of 5.693 subjects (70%) in total. The first phase of the study was performed in all patients, while the second phase recruited patients with proteinuria and microhematuria.
Different levels of chronic renal failure were detected in 62 examinees, of whom 13 subjects had symptoms and signs of endemic nephropathy. Proteinuria was of glomerular type. Histopathological changes in the early stage indicate that mesangio-proliferative glomerulonephirtis is the most common form in patients with intermittent proteinuria, while persistent proteinuria was frequently accompanied by membrano-prolipherative, and more commonly by lobular glomerulonephritis.
Endemic nephropathy begins at an earlier age, and contrary to other authors, we have detected endemic nephropathy among inhabitants of the urban regions as well. Mesangioprolipherative glomerulonephritis is the most common form, but patients with persistent proteinuria frequently suffer from membranoproliferative and lobular glomerulonephritis. Acta Medica Medianae 2011;50(4):79-85.
Key words: endemic glomerulopathy, proteinuria, complement, microhematuria