Balkan Endemic Nephropathy Etiology: A Link to the Geological Environment
Calin A. Tatu1, 4, William H. Orem2, Gerald L. Feder3, Virgil
Paunescu4, Victor Dumitrascu4, Diana N. Szilagyi4, Robert B.
Finkelman2, Florin Margineanu5, and Francisc Schneider6
1 Forslys Group, Arad, Romania
2 US Geological Survey, Reston, VA, USA
3 Florida Community College at Jacksonville, Jacksonville, FL, USA
4 Department of Immunology, Clinical Laboratory No. 1, Timisoara, Romania
5 Center of Hemodialyis, County Hospital, Drobeta Turnu Severin, Romania
6 Department of Physiology, Western University “Vasile Goldis”, Arad, Romania
Corresponding author: Calin A. Tatu
Forslys Group
RO-2900 Arad
Str. Vasile Goldis 1-3, Sc.2 Et.3 Ap.10
Romania
Telephone: (+40) 92 607490
E-mail: cta@med.unc.edu
CEJOEM 2000, Vol.6. No.2-3.:138-150
Key words:
Balkan endemic nephropathy, Pliocene lignite, medical geology, and geomedicine
Abbreviations:
BEN = Balkan endemic nephropathy;
GC/MS = gas chromatography/mass spectrometry;
TDS = total dissolved salts
Abstract:
A medical problem debated for more than 40 years, Balkan endemic nephropathy (BEN) is presently considered to be an environmental disease caused by low rank coal derived toxic compounds leached into the well drinking water used by the people in the endemic villages. Our study provides new support to this hypothesis, describing a close topographical correlation between the location of several visited BEN endemic villages from Romania and the location of low rank Pliocene coal (lignite) deposits of unique quality. The analysis of 22 water samples collected from eight endemic villages and two non-endemic sites reveals no significant difference in the pH, conductivity or total dissolved salt concentration between the endemic vs. non-endemic water sources, the difference being most likely in the organic composition. Gas chromatography/mass spectrometry analysis of Pliocene lignite methanol extracts of endemic regions shows a peculiar composition, differing from the methanol extracts of coals collected from non-endemic places. The Pliocene lignite composition is dominated by highly functional aromatic compounds, some of which are potentially nephrotoxic/carcinogenic, that can reach the ground water but are not present in the other two analyzed coal samples. The geological history of the endemic regions is assessed, and a correlation is described between the placement of the BEN regions from Romania, Bulgaria, and former Yugoslavia and the corresponding margins of the Balkan Peninsula's major Tertiary parathetic basins.
Received: 31 July 2000
Accepted: 14 September 2000
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