Author/Editor		Ferluga, D; Vizjak, Alenka; Hvala, Asta; Vodovnik, A; Trnačević, S; Halilbašić, A
Title		A kidney biopsy study of early endemic nephropathy
Type		članek
Source		In: Čvorišćec D, Čeović S, Stavljenić-Rukavina A, editors. Endemic nephropathy in Croatia. Zagreb: Academia Croatica scientiarum medicarum,
Publication year		1996
Volume		str. 43-72
Language		eng
Abstract		The pathogenesis of endemic nephropathy (EN) is still unclear because of a limited number of kidney biopsy studies of earlier stages and lack of a biopsy follow-up. Introducing the standard light, immunofluorescence and electron microscopy techniques, we analyzed kidney biopsy specimens of 50 patients who met the criteria for EN, and of 50 age-matched control subjects. Semiquantitative histomorphologic and statistical analysis confirmed a highly significant increase in the incidence and extent of global glomerular sclerosis, vascular sclerosis and hyalinosis, and tubular atrophy accompanied by interstitial fibrosis in EN patients in comparison with the age-matched control group, possibly suggesting intensified aging processes. Other peculiar histomorphologic abnormalities of the incidence and extent were identified in EN patients only. The occurrence of multifocal double-outlined glomeruli, mucoid thickening of small blood vessels and transmural hyalinosis could be interpreted as a focal chronic thrombotic microangiopathy with endothelial cells as a key target. The similarity of etiologically still enigmatic EN with chronic cyclosporine, radiation, metal, ochratoxin A, and nephropathy induced by aristolochic acid was emphasized by comparing histomorphologic characteristics of EN recorded in this study with human and animal histology of etiologically confirmed renal diseases. Our original preliminary results suggested a significance of interstitial capillarosclerosis in EN. Viruses as tentative etiologic agents in EN appear to be much less probable than physicochemical agents. Our study resurfaces the hypothesis that aristolochic acid might be involved in the pathogenesis of EN.
Descriptors		BALKAN NEPHROPATHY BIOPSY, NEEDLE MICROSCOPY, ELECTRON AGE FACTORS FLUORESCENT ANTIBODY TECHNIQUE NEPHRITIS, INTERSTITIAL BOSNIA-HERZEGOVINA