What is Balkan Nephropathy?

Abbreviated as BEN by AbbreviationFinder.org, the Balkan nephropathy is a form of interstitial nephritis, which occurs only in the Balkan States. It is a chronic kidney disease that is always fatal without treatment. There is no causal therapy yet.

What is Balkan Nephropathy?

As the name suggests, Balkan nephropathy is a kidney disease that has so far only occurred in the Balkan countries. The rural areas of the Danube Valley are particularly affected by this disease. The disease is also widespread among the rural population in some side valleys in the Balkans.

There are regular reports of illnesses in Bulgaria, Romania, Serbia, Croatia and Bosnia. It is therefore also spoken in the technical language of an endemic (native) spread of the disease. Balkan nephropathy is a special form of interstitial nephritis.

Interstitial nephritis is a very rare disease anyway, which is characterized by inflammatory processes in the kidney tubules. Approximately seven to fifteen percent of all interstitial nephritis cases result in acute kidney failure. However, Balkan nephropathy is a chronic inflammatory disease of the kidneys, which always leads to renal insufficiency and is usually fatal.

It is often associated with an otherwise rare cancer growth in the urothelial tissue. The disease was first described in 1954 or 1955. In 1956 it was added to the catalog of officially recognized diseases. Balkan nephropathy can be clearly distinguished from other forms of nephropathy. The high blood pressure, which is often the norm, is missing at the beginning of the disease process. High blood pressure only appears as a symptom in the later stages of the disease.


Much has been speculated about the cause of the Balkan nephropathy. Environmental influences that are particularly pronounced in the Balkan countries were suspected at an early stage. At first, mold toxins, herbal medicines, heavy metals, a lack of trace elements or viruses were considered.

In 2007, however, a research group at Stony Brook University in the United States published research on Balkan nephropathy that led to its main cause. In this study it was found that the flour from this region was contaminated with a toxin which came from the seeds of the common easter egg. This toxin is a mixture of aristolochic acids.

The disease only broke out in people from the local population who had lived in this region for more than 15 years. The common easter lucei is not uncommon in this region and is a common field weed there. Since the farmers there are very poor, it has so far not been possible for them to use expensive herbicides to destroy the weeds.

As a result, the poisons get into the flour again and again and are baked in the bread. Aristolochic acids are secondary plant substances, so-called alkaloids, which mainly occur in the roots of the easter lucei. They have a very high toxic potential. Their very high genotoxicity was demonstrated in in-vivo and in-vitro studies.

At the same time, they are also nephrotoxic. In the genome, under the influence of aristolochic acids, there is often a conversion from AT to TA nucleotide bases. The aristolochic acids bind covalently to the DNA and form adducts that are normally removed again via repair mechanisms. However, this does not always succeed, so that the mutation rate is extremely high.

The aristolochic acids leave behind changes in the regions where the genome ends. These changes mean that the reading process on the gene begins at a completely different point. This leads to the formation of the wrong proteins which do not lead to the desired effect. Since the cancer suppressor gene p53, which controls cell division, is often affected, uncontrolled cell growth in the urothelial tissue can occur.

With constant uptake of the poisons, more and more adducts are formed from DNA and aristolochic acids, which are accumulated in the kidney cortex. The result is chronic inflammatory processes that lead to the destruction of the kidneys. At the same time there is cancer growth in urothelial tissue. The process is progressing and cannot be stopped with today’s therapy methods.

Symptoms, ailments & signs

The symptoms of Balkan nephropathy are very unspecific as in other interstitial nephritis. At first, the disease can remain asymptomatic. There are increased protein concentrations in the urine. There is a polyuria, the body loses vital salts. Urinary tract infections are also common.

In addition, a mild anemia develops. High blood pressure develops later, which is not yet present at the beginning. In addition to interstitial nephritis, there is often a malignant tumor in the urothelial tissue. In the end-stage of the disease, chronic kidney failure occurs, which is usually fatal. The prognosis for Balkan nephropathy is usually poor.

Diagnosis and course

Balkan nephropathy can be diagnosed by taking a comprehensive medical history and laboratory tests for protein in the urine. The α1-microglobulin in particular is increased in the urine.


Unfortunately, Balkan nephropathy cannot be treated and is chronic. It usually leads to death. In most cases of Balkan nephropathy, there are initially no noticeable symptoms that the patient could complain about. There is an increased level of protein in the urine.

However, this cannot be determined without tests. The body often loses salts, which also decreases the patient’s thirst. Urinary infections are very common due to Balkan nephropathy. This can be noticeable as pain when urinating.

The Balkan nephropathy leads to high blood pressure in the patient. Often a tumor forms, which cannot be detected without an examination by the doctor. There is no cure for Balkan nephropathy. However, the patient can live with the disease for a long time.

However, high blood pressure and kidney infections should be treated. This is mostly done with the help of medication or surgery. How long the patient will live with Balkan nephropathy cannot be predicted.

When should you go to the doctor?

People returning from a long stay in the Balkans should seek medical advice if they suspect Balkan nephropathy. This is particularly recommended if grain products were regularly consumed in the region. Since the disease is particularly widespread in the side valleys in the south of the country and in the rural areas of the Danube Valley, returnees from these regions are particularly at risk. In general, however, Balkan nephropathy only breaks out among the local population.

People of origin from the Balkans should therefore definitely discuss the symptoms with their family doctor. For people from other regions of the world there is no reason to suspect Balkan nephropathy behind the symptoms. Anyone who suffers from typical complaints such as high blood pressure, urinary tract infections and anemia should still consult a doctor.

Although these symptoms are rarely due to Balkan nephropathy, they suggest another condition. Clarification and treatment of the complaints is always necessary. In addition to the family doctor, you can also go to the ENT doctor and other knowledgeable specialists with the complaints.

Treatment & Therapy

There is no causal treatment of Balkan nephropathy. Of course, the absorption of the aristolochic acids must be stopped. However, this does not stop the disease process.

Therapy today refers to the treatment of complications caused by urinary tract infections or high blood pressure. This therapy can extend life. As things stand today, it is not yet possible to cure the disease.

Outlook & forecast

The prognosis outlook for Balkan nephropathy is very unfavorable. The disease is considered incurable and usually ends when death occurs. After the onset of the disease, the patient steadily loses vital energy.

Various complaints arise. They include infections, circulatory disorders, and changes in protein levels in the body. In addition, organ failure occurs in the further course and ultimately the patient dies prematurely.

After many years of intensive research, scientists were able to find out that the cause of the symptoms is poisoning of the body. With the current medical possibilities, however, this cannot be treated or treated to a sufficient extent. Despite all efforts, there is no antidote to date. Therefore, doctors focus on life-prolonging measures for the patient. These should maintain well-being for as long as possible and extend a life with the disease. Various symptoms can be successfully treated in parallel, which improves the existing quality of life.

However, a cure for Balkan nephropathy is not possible and the patient loses the battle against the disease. Without medical care, death occurs much faster. Neither self-healing powers nor alternative healing methods have so far been able to assert themselves against the poisoning of the organism.


The best prevention of Balkan nephropathy would be to treat the fields with herbicides in the relevant countries to combat the common easter luze. The prerequisite for this, however, is also the fight against the poverty of the farmers there.


Balkan nephropathy – a chronic kidney disease caused by intoxication – is limited to a few regions of the world. Scientists found the cause of the emergence of the Balkan nephropathy in a poisonous field weed. For years this was baked with the ground grain to make bread. Only pesticides could have prevented this. The long-term consumption of contaminated flour led to irreparable kidney damage in many people in these regions.

At best, follow-up care after the diagnosis of Balkan nephropathy can monitor that the existing kidney disease does not develop into a cancer of the lower urinary tract. If, for this reason, surgery were to be carried out with less kidney damage, postoperative follow-up care as part of the oncological treatment could be necessary.

As a rule, however, the Balkan nephropathy results in renal insufficiency. In most cases, their course and severity relieve the physician from follow-up care. Very few of those affected will survive this disease long enough. Since the Balkan nephropathy only occurs in poor rural areas of the Balkans, surgical measures such as a kidney transplant are often out of the question. This could potentially save some of those affected.

However, poisoning from the contaminated flour that has been eaten for years is usually well advanced. In addition, there are hardly any modern medical options available to the people in the affected regions. So it looks bad with aftercare.

You can do that yourself

Since patients can live with this disease for a long time, it is important to keep the various side effects in check. These include, for example, infections, changes in the concentration of protein in the body, high blood pressure and impaired blood circulation. Even if the disease process itself can no longer be stopped, targeted therapies can increase the vital energy.

Due to the variety of complaints, it is advisable for the patient to consult several doctors. Usually the family doctor suggests a visit to the ENT doctor and to knowledgeable specialists. It is important to pay attention to the various symptoms. A parallel treatment can improve the patient’s quality of life. It is very important to have the urine tested for protein, as the increased protein value cannot be determined without tests.

Since the body often loses salts, the patient’s thirst decreases. This must be prevented. For this reason it is indispensable in the case of Balkan nephropathy to take a close look at one’s own drinking behavior. Those who pay attention to their body and have the symptoms treated in a targeted manner ultimately gain in life and quality of life.

Balkan Nephropathy