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Archives of Industrial Hygiene and Toxicology

The Journal of Institute for Medical Research and Occupational Health


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Mycotoxic and Aristolochic Acid Theories of the Development of Endemic Nephropathy

Maja Peraica1 / Ana-Marija Domijan1 / Marko Šarić1

Institute for Medical Research and Occupational Health, Zagreb, Croatia1

This content is open access.

Citation Information: . Volume 59, Issue 1, Pages 59–65, ISSN (Print) 0004-1254, DOI: https://doi.org/10.2478/10004-1254-59-2008-1865, April 2008

Publication History

Published Online:
2008-04-11

Mycotoxic and Aristolochic Acid Theories of the Development of Endemic Nephropathy

Despite many efforts of scientists and epidemiologists, the aetiology of endemic nephropathy (EN) is still unknown. This disease occurs in the rural population of geographically limited areas of Bulgaria, Bosnia and Herzegovina, Croatia, Romania, and Serbia, and a number of theories have been proposed about its aetiology. The mycotoxin theory has prevailed until now, based on the studies of nephrotoxic mycotoxin ochratoxin A (OTA) that revealed higher frequency of OTA-positive food and blood samples in endemic than in non-endemic areas.

However, a new aristolochic acid (AA) theory of EN origin has been proposed recently, due to the histological similarities in kidney lesions between patients suffering from EN and patients suffering from Chinese herbs nephropathy caused by AA. Until now it has not been unequivocally proved that the inhabitants of EN areas are exposed to higher concentration of AA than in other regions and the exposure pathways are rather uncertain.

This paper presents most important studies supporting both theories, indicating also the inconsistencies of each.

Mikotoksinska i aristolohina teorija o uzroku endemske nefropatatijee

Unatoč mnogim nastojanjima znanstvenika i epidemiologa, etiologija endemske nefropatije (EN) još nije razjašnjena. Postavljeno je više teorija o nastanku ove bolesti koja se javlja u ruralnom stanovništvu na geografski ograničenim područjima Bugarske, Bosne i Hercegovine, Hrvatske, Rumunjske i Srbije. Donedavno se najviše napora ulagalo u istraživanje povezanosti nastanka EN s izloženošću mikotoksinu okratoksinu A. Prikupljeni rezultati upućuju većim dijelom na opravdanost te pretpostavke. Zbog histoloških sličnosti bolesnika s EN i pacijentica koje boluju od nefropatije uzrokovane kineskim travama za koju je ustanovljeno da ju uzrokuje aristolohična kiselina (AA) postavljena je teorija da je AA uzročnik EN. Dosad nije potvrđeno da su stanovnici na lokalizacijama s endemskom nefropatijom izloženi povišenim koncentracijama AA u usporedbi s područjima bez te bolesti. Osim toga su i putovi izloženosti AA koji bi se mogli povezati s pojavom EN nejasni i nedokazani.

U ovom preglednom radu izneseni su rezultati najvažnijih istraživanja koja podupiru ili negiraju obje teorije, zajedno s nedostatcima svake od njih.

Keywords: Chinese herbs nephropathy; DNA adducts; kidney tumours; mycotoxins; ochratoxin A; p53

Keywords: DNA-adukti; mikotoksini; nefropatija kineskih trava; okratoksin A; p53; tumori bubrega

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