Increased Blood Pressure in Adult Offspring of Families With Balkan Endemic Nephropathy: A Prospective Study

Plamen S. Dimitrov; Valeri A. Simeonov; Svetlana D. Tsolova; Angel G. Bonev; Rossitza B. Georgieva; Wilfried J. Karmaus


BMC Nephrology 

In This Article


There is a large body of evidence that patients with Balkan Endemic Nephropathy (BEN), in contrast to other chronic kidney diseases,[1,2] do not manifest increased blood pressure.[3,4,5,6,7,8,9] However, little is known about the development of blood pressure in BEN patients, in particular, whether increased blood pressure occurs in preclinical stages. BEN was first characterized in the Vratza District, Bulgaria in 1956.[10] Later, similar nephropathies were described in Yugoslavia in 1957[3,10] and in Romania in 1961.[11] As a result, in 1964, the disease was recognized as a new nosological entity and was named Balkan Endemic Nephropathy. BEN is a tubulo-interstitial kidney disease that progresses slowly for many years. The final disease stage is characterized by renal failure and shrinkage of both kidneys to 3-4 cm in length.[12] Recent studies have shown that the offspring of BEN patients have smaller kidney lengths or cortex widths,[13,14] which may be a marker of a reduced number of nephrons.[15,16] Mackenzie et al. advanced the hypothesis that the total nephron number is a factor determining susceptibility to increased blood pressure.[17] In addition, there is evidence that the number of nephrons co-determines kidney dimensions.[18] Lastly, Singh et al. and Zumrutdal et al. have shown that decreased kidney dimensions are associated with increased systolic blood pressure.[16,19]

We conducted a prospective study in the Vratza District of Bulgaria, a rural area, and measured the kidney cortex width, kidney length, and blood pressure of the offspring of BEN patients and control offspring at two time points, one year apart. We hypothesize the following:

  • A smaller kidney cortex width is related to a higher average systolic blood pressure and a higher pulse pressure.

  • An offspring with parental history of BEN has a higher average systolic blood pressure and a higher pulse pressure.


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