| Popis: |
Panonian-Balkan endemic uropathy (PBEU) has recently been defined as a single rural household environmental disease of the entire urinary tract due to common living conditions and nourishment, with imprecisely defined, but usually long latency. Seemingly various clinical manifestations, including chronic renal failure due to endemic tubulointerstitial nephropathy, renal cell carcinoma (RCC) and urotheliomas of all localities, observed with significantly higher frequency in the affected population, represent a complex, however, one unique nosological entity which can be found in one single patient. This conclusion is based on results of previous research by Croatian and foreign investigators, as well as our own recent research. The starting point of our investigation of the endemic occurrence of RCC, as the integral part of the clinical picture of PBEU, was an epidemiological reappraisal of the five essential previously published studies from Croatia and Serbia, covering the period from 1951 to 1990. Our aim was to assess whether RCC occurs with considerably higher frequency in the endemic area or not. Due to insufficient statistical analysis of their results none of the authors of previous reports observed a definite correlation between RCC and endemic nephropathy. In our comparison of RCC frequency in endemic vs. non-endemic areas we used the chi-square test. Statistical analysis of raw data from insufficiently analyzed tables disclosed highly significant frequency of RCC occurrence in the endemic area. Because of omissions in statistical analysis authors of previous studies failed to recognize this phenomenon. We conclude that RCC, although unrecognized, has occurred with significantly high frequency in endemic areas of Croatia and Serbia since the very beginning of the research on PBEU in 1951 until these days. This conclusion has prompted us to continue our research on epidemiological and clinical characteristics of endemic RCC in the endangered area. This epidemiological reappraisal revealed the extent of one of numerous gaps in comprehension of the complex problem of PBEU. |
