Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2003) 64, 1817–1821; doi:10.1046/j.1523-1755.2003.00280.x
Urinary neopterin concentrations in patients with Balkan endemic nephropathy (BEN)
Draga Toncheva, Angel S Galabov, Andreas Laich, Srebrena Atanassova, Bojin Kamarinchev, Tzvetan Dimitrov and Dietmar Fuchs
Institute of Medical Chemistry and Biochemistry, Leopold Franzens University, Innsbruck, Austria; Department of Medical Genetics, Medical University, Sofia, Bulgaria; Stephan Angeloff Institute of Microbiology, Bulgarian Academia of Sciences, Sofia, Bulgaria; Military Medical Academy, Sofia, Bulgaria; Alexandrovska University Hospital, Sofia, Bulgaria; and Ludwig Boltzmann Institute of AIDS-Research, Innsbruck, Austria
Correspondence: Dietmar Fuchs, Institute for Medical Chemistry and Biochemistry, Fritz Pregl Strasse 3, A-6020 Innsbruck, Austria. E-mail: dietmar.fuchs@uibk.ac.at
Received 24 January 2003; Revised 21 March 2003; Re-revised 20 June 2003; Accepted 2 July 2003.
Abstract
Urinary neopterin concentrations in patients with Balkan endemic nephropathy (BEN).
Background
Balkan endemic nephropathy (BEN) is of great clinical importance in restricted areas of Bulgaria, Serbia, Croatia, Bosnia, Herzegovina, and Romania, since the etiology of BEN is still unknown.
Methods
In urine samples from 48 patients (41 females and 7 males, aged 65.6 
6.87 years) with BEN living in an endemic area of Vratza district, Bulgaria, neopterin concentrations were measured by high-pressure liquid chromatography (HPLC) and compared with other clinical and laboratory investigations, including creatinine, hemoglobin, and erythrocyte sedimentation rates (ESRs).
Results
Urinary neopterin concentrations were 263 128 (mean SD; range, 78 to 786 
mol/mol creatinine), 24 (50%) of BEN patients presented with increased concentrations as compared to the established normal ranges. Average ESRs were increased (1 hour, 29.0 14.7 mm/hour) and hemoglobin was decreased (109.3 16.4 g/L). Hemoglobin correlated inversely with ESRs (rs = -0.787 and –0.780) and creatinine concentrations (r = -0.690, all P < 0.001), but not with neopterin concentrations. Neopterin concentrations also did not correlate with serum creatinine levels. There existed an age relationship of ESR, creatinine, and hemoglobin, but not of neopterin. Neopterin concentrations were slightly lower in five females with low titers of antibodies against local B1 hantavirus strain (P < 0.05).
Conclusion
The findings can support an immune-mediated inflammatory process in the pathogenesis of BEN only in a subgroup of patients.
Keywords:
Balkan endemic nephropathy, neopterin, urinary
