Some pathomorphological features of Balkan endemic nephropathy in Croatia

Over the last 16 years, 214 autopsies were done at the Department of Pathology and Forensic Medicine, Slavonski Brod Medical Centre, on people from an area recognized as endemic for Balkan nephropathy in the county. Balkan endemic nephropathy was diagnosed pathoanatomically and histopathologically in 94 of these cases, and in none of 1040 autopsies on people from a nonendemic area. The most striking pathological finding in all advanced cases of the disease was a marked reduction in kidney size and weight; in one extreme case, the organ weighed only 20 g. The process is invariably bilateral, but there are considerable differences in the degree of involvement in each pair. Although the pathoanatomical changes, including lung oedema and haemorrhage and fibrinous pericarditis, are seen in the majority of cases, they are not considered to be specific for Balkan endemic nephropathy, since they are well recognized signs of long-standing primary uraemia. The relevance of the peculiar finding of sulfurous yellow discoloration and hardened subcutaneous adipose tissue, seen frequently post mortem, is unknown and should be investigated in more detail. Histopathologically, fibrosis and atrophy of kidney cortex, with tubular degeneration, are the most consistent findings. Lesions characteristic of pyelonephritis were superimposed over the picture of 'pure' Balkan endemic nephropathy in a considerable number of cases.