Vol. 9, No 1, 2002 pp. 39 - 48
UC 616.61-004
ENVIRONMENT, GEOCHEMISTRY AND THE ETIOLOGY
OF BALKAN ENDEMIC NEPHROPATHY: LESSONS FROM
ROMANIA
William H. Orem1, Calin A. Tatu2*,
Gerald L. Feder3, Robert B. Finkelman1,
Harry E. Lerch1,
Susan V.M. Maharaj4, Diana Szilagyi2,
Victor Dumitrascu2, Virgil Paunescu2,
Florin Margineanu5
1US Geological Survey, 12201 Sunrise
Valley Drive, MS 956, Reston, VA 20192, U.S.A.
2Department of Immunology, Clinical
Laboratory No.1, Pta. E. Murgu No.2, RO-1900 Timisoara, Romania
3Florida Community College at Jacksonville,
Jacksonville, FL 32256,U.S.A.
4Department of Environmental &
Toxicologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska
Ave. N.W., Washington, D.C. 20306-6000, U.S.A
5Center of Hemodialysis, County Hospital,
82 Unirii Str., RO-1500, Drobeta Turnu Severin, Romania
* E-mail: cta@med.unc.edu
Summary. Balkan endemic nephropathy (BEN) is a fatal chronic kidney
disease of unknown etiology geographically restricted to several countries
of the Balkan Peninsula and described for the first time almost 50 years
ago. Along time, many factors have been proposed as etiological agents
for BEN (including viruses, bacteria, mycotoxins, industrial pollution,
radioactive compounds, etc.) but none of these have been confirmed. However,
in the recent years, based on field and laboratory investigations, an environmental
etiology of the disease has become more widely accepted, with a prime role
played by the geological background of the endemic settlements. In this
regard, the most incriminated are toxic organic compounds present in the
drinking water, supposed to be leached by the groundwater from low rank
Pliocene lignite deposits adjacent to the endemic villages and transported
into shallow household wells or springs.
We describe in our study several inorganic and organic geochemical
features of water samples collected from the endemic villages, in comparison
with water samples from nonendemic locations from Romania. Water samples
were analyzed on site and in the laboratory using standard inorganic and
organic geochemistry methods. Methanol and aqueous extracts of Pliocene
lignite collected from the endemic areas were also analyzed by GC/MS.
While no significant difference could be found in the inorganic parameters
(i.e., pH, TDS, anions, alkalinity, oxygen, nitrates, etc.) of the endemic
vs. nonendemic water samples, the organic content, as revealed by GC/MS,
is more complex and much more higher in the endemic vs. the nonendemic
water samples. Also, the Pliocene lignite from the endemic areas seems
to have a particular geochemical composition, with many potentially nephrotoxic/carcinogenic
aromatic and nonaromatic molecules, leachable into organic solvents as
well as into water.
Some of the molecules extracted from the endemic area Pliocene lignite
are apparently present in the endemic water samples, suggesting their origin
in coal and sustaining the Pliocene lignite hypothesis for BEN etiology.
Key words: Balkan endemic nephropathy, medical geology, geomedicine,
Pliocene lignite, GC/MS
