Evaluacija dijagnostičkih kriterija za endemsku nefropatiju

EN is a chronic aristolochic acid nephropathy whose prevalence has not been changed significantly in the last 3 decades. In EN villages there has been a shift towards an older age in diagnosing EN. We do not expect the development of EN in persons in the WHO subgroups of others and those at risk because at their age (45-50 yrs) 30 years ago there were persons in WHO subgroup of the diseased, but in this study the persons in the subgroups of others and those at risk do not have the signs of kidney disease. The aforementioned data rise the question of the exposure to etiological agent 30 years ago as well as the question of plausible disappearance of EN. Anemia, a characteristic of a chronic kidney disease, has not shown to be a good marker in differentiating WHO subgruops and therefore should not be used as a diagnostic criterion for EN. Furthermore, there was no difference in blood in urinary dipstick test between EN and control villages as well as among the study subgroups, Therefore, this test is not a good screening tool in detecting those with urothelial tumor among farmers in EN villages. Although the early phase of EN is characterized by the proximal tubule damage, the proximal tubule enzyme LAP has not shown to be a good marker in differentiating the study subgroups. Moreover, the progression of EN, especially in the advance stage of the disease is characterized by interstital renal fibrosis and TGF beta in renal fibrosis plays a central role (99). Several studies have shown no correlation between urinary TGF beta and histological findings of renal fibrosis (153, 171). In our study urinary TGF beta has not shown to be a good marker in differentiating the study subgroups. In our study the assesment of kidney function by MDRD formula as well as both kidney lenght and parenchima thickness, have shown to be good markers in differentiating the study subgroups and therefore should be implemented into the diagnostic criteria for EN. Also, alpha 1mCR has shown to be a great marker in screening and diagnosing EN in the study, Based on our results the cut off value of alpha 1mCR for screening should be 23,5 mg/g creatinine instead of 15 mg/g creatinine in the present criteria, while for making a diagnosis of EN 31,5 mg/g creatinine. Positive family history for EN increases 5,8 times the risk for developing EN compared to a negative one. Therefore, positive family history for EN is an important criterion for screening and diagnosing EN. Taken together, persons with positive family history for EN, i.e. WHO subgrup of those at risk as well as those with alpha 1mCR greater than 23,5 mg/g creatinine who in our study partly represent persons in the WHO subgroup of suspected of having EN, are persons with greater risk for developing EN and therefore should be regularly followed up by their GPs.