ENDEMSKA NEFROPATIJA – BOLEST KOJA ZAHTEVA DALJA ISTRAŽIVANJA
Abstract
Endemska nefropatija (EN) je hronična, tubulointersticijalna bolesti opisana pre 60 godina u ograničenim područjima Jugoistočne Evrope. Upkos brojnim istraživanjima ova bolesti i dalje privlači pažnju istraživača zbog većeg broja nerešnih pitanja. Nekima od tih pitanja posvećen je ovaj rad.
Obimna terenska istražaivanja sprovedena sedamdesetih godina prošlog veka u svim područjima ugroženim EN su pokazala različitu prevalenciju bolesti koja se kretala od 0,3% do 10%. Početkom ovog veka pojavila su se oprečna mišljenja o incidenciji bolesti, od pretpostavke da bolest iščezava do podataka da se incidencija ne menja značajno. Ove razlike su nastale kako zbog malog broja skrining studija urađenih tokom prethodnih 30 godina, tako i zbog velikih migracija stanovnika iz endemskih sela. Zato nema tačnih podataka o prevalenciji EN u endemskom područjima, a ni podataka o obolevanju emigranata iz endemskih naselja.
EN je porodična bolest koja se javlja samo u pojedinim žarištima pa se zato smatra da u njenom nastanku učestvuju genetski činioci i činioci spoljne sredine. Danas su aktuelne tri hipoteze o etiologiji EN. Jedna od najstarijih je ona o ohratoksinu A ali se najviše pažnje poklanja aristolohijskoj kiselini kao uzorku EN. Nije isključeno da su policiklični aromatični ugljovodonici i druga toksična organska jedinjenja poreklom iz lignita uzročnici EN.
Dosadašnja istraživanja nisu otkrila nijedan biomarker koji bi imao dovoljnu specifičnost i senzitivnost za otkrivanje i dijagnozu EN. Zato su definisani dijagnostički kriterijumi, koji predstavljaju kombinaciju epidemioloških, kliničkih i laboratorijskih parametara. Tokom proteklih decenija različite istraživačke grupe su koristile različite dijagnositčke kriterijume, što je otežavalo poređenje rezultata. Zbog toga je nedavno grupa ekpserata donela usaglašene preporuke za skrining, dijagnozu, klasifikaciju i lečenje EN. Međutim, kako ne postoji patognomoničan biomarker za EN, dijagnoza bolesti se postavlja na osnovu dokazivanja prisustva definisanih kriterijuma i isključivanja drugih bolesti bubrega. To ukazuje da traganje za specifičnim biomarkerom EN treba nastaviti.
Sve to govori da i posle 60 godina istraživanja EN postoje nerešena pitanja koja zahtevaju dalja istraživanja primenom savremenih metoda.
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