Maharaj S V M
Int J Occup Environ Health. 2014 Jan-Mar;20(1):77-91. doi: 10.1179/2049396713Y.0000000046.
Balkan endemic nephropathy (BEN) is a chronic, tubulointerstitial renal disease often accompanied by urothelial cancer that has a lethality of nearly 100%.
One of the many factors that have been proposed to play an etiological role in BEN is exposure to organic compounds from Pliocene lignite coal deposits via the drinking water in endemic areas.
The objective of this study was to systematically evaluate the role of the tenets of the Pliocene lignite hypothesis in the etiology of BEN in order to provide an improved understanding of the hypothesis for colleagues and patients alike.
A comprehensive compilation of the possible limitations of the hypothesis, with each limitation addressed in turn is presented.
The Pliocene lignite hypothesis can best account for, is consistent with, or has the potential to explain the evidence associated with the myriad of factors related to BEN.
Residents of endemic areas are exposed to complex mixtures containing hundreds of organic compounds at varying doses and their potentially more toxic (including nephrotoxic) and/or carcinogenic metabolites; however, a multifactorial etiology of BEN appears most likely.
巴尔干地方性肾病（BEN）是一种慢性肾小管间质性肾脏疾病，常伴有尿路上皮癌，致死率近100%。
在诸多被认为在BEN病因中起作用的因素中，有一个因素是通过流行地区的饮用水接触上新世褐煤矿床中的有机化合物。
本研究的目的是系统评估上新世褐煤假说的原理在BEN病因中的作用，以便为同事和患者更好地理解该假说。
全面汇编该假说可能存在的局限性，并依次对每个局限性进行阐述。
上新世褐煤假说最能解释、与BEN相关的众多因素的证据一致或有潜力解释这些证据。
流行地区的居民接触到含有数百种有机化合物的复杂混合物，这些化合物剂量各异，其潜在毒性（包括肾毒性）和/或致癌代谢物更强；然而，BEN的多因素病因似乎最有可能。
