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Evaluation of the hypothesis that Balkan endemic nephropathy is caused by drinking water exposure to contaminants leaching from Pliocene coal deposits

Journal of Exposure Science & Environmental Epidemiology volume 16, pages 515–524 (2006)Cite this article

Abstract

Balkan endemic nephropathy (BEN) is a kidney disease that has been reported in only certain rural villages in Serbia, Bulgaria, Romania, Croatia and Bosnia. The cause of BEN remains a mystery, but researchers seem to agree that exposure to one or more environmental agents is at least partially responsible. The Pliocene lignite hypothesis suggests the disease is due to long-term exposure to polycyclic aromatic hydrocarbons (PAHs) or other toxic organic compounds that have leached into drinking water supplies from low-rank coals. Although this hypothesis has been promoted by some researchers, efforts to substantiate it have been inconclusive due to limitations in sample size and methodology. The present study was designed to further examine this hypothesis by analyzing PAHs, which were implicated in the original hypothesis, in a larger number of water samples from endemic and nonendemic villages in Bulgaria and for other chemical differences between the villages. Results show that levels of all PAHs were low, with none exceeding the drinking water standard for benzo-[a]-pyrene, the most toxic PAH, and the only one for which a maximum contaminant level (MCL) has been set for drinking water. Comparison of additional unidentified chromatographic peaks from high-pressure liquid chromatography (HPLC) technique designed to detect dissolved organic compounds (DOCs) that leach from coal failed to show higher levels in BEN villages. This study finds no basis to connect PAHs or other unknown DOCs to the etiology of BEN, and suggests that the evidence in support of the Pliocene lignite hypothesis is limited to the spatial association originally proposed.

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Acknowledgements

This study was supported by Grant 2 D43 TW00-641 from the Fogarty International Center, National Institutes of Health, USA, and by Grant SfP971905 from the North Atlantic Treaty Organization (NATO), both to the Institute of International Health at Michigan State University.

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Authors and Affiliations

  1. Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA

    Thomas C Voice & Shawn P McElmurry

  2. Department of Geological Sciences, Michigan State University, East Lansing, MI, USA

    David T Long

  3. Department of Biostatistics and Social Epidemiology, National Center of Public Health Protection, Sofia, Bulgaria

    Plamen Dimitrov

  4. Department of Chemistry and Biochemistry, Medical University of Sofia, Sofia, Bulgaria

    Varban S Ganev

  5. Institute of International Health, Michigan State University, East Lansing, MI, USA

    Evangelos A Peptropoulos

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  1. Thomas C Voice
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Correspondence to Thomas C Voice.

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Voice, T., McElmurry, S., Long, D. et al. Evaluation of the hypothesis that Balkan endemic nephropathy is caused by drinking water exposure to contaminants leaching from Pliocene coal deposits. J Expo Sci Environ Epidemiol 16, 515–524 (2006). https://doi.org/10.1038/sj.jes.7500489

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