Samardzic Josip, Hasukic Sefik
General Hospital Josip Bencević, Slavonski Brod, Croatia.
Department of Surgery, University Clinical Center Tuzla, University of Tuzla, Faculty of Medicine, Tuzla, Bosnia and Herzegovina.
Med Arch. 2017 Dec;71(6):430-433. doi: 10.5455/medarh.2017.71.430-433.
Endemic nephropathy (EN) is a chronic tubulointerstitial renal disease associated with increased incidence of upper urinary tract urothelial cancer (UTUC) occurring predominantly in geographically limited areas in villages along big Danube river. Based on results obtained by the research it is confirmed that aristolochic acid is causative agent of endemic nephropathy (EN).
The aim of this study was to determine characteristics of UTUC in two endemic areas and analyze trends in 5-year period.
This study included all patients with UTUC with or without synchronous/metachronous urothelial cancer in urinary bladder, from Croatian and Bosnian EN and non-EN regions. We analyzed archival data bases from all patients with UTUC who were admitted and operated in Department for surgery and urology, General Hospital Josip Bencevic Slavonski Brod in the time period between 2005 and 2010. Analyzed groups of patients were divided and compared as EN group (that includes patients from Croatian and Bosnian EN region) and non-EN group (that includes patients from Croatian and Bosnian non-EN region). All surgical specimens were processed according to standardized pathological procedures.
Comparing patients basic characteristics from Croatian and Bosnian EN region there was no significant difference in gender (females were more frequently affected in both EN regions, p=0.99) or age (p=0.43) of patients. We found higher blood levels of urea and creatinine in group of patients from Croatian EN region when compared with group of patients from Bosnian EN region but the difference was not statistically significant (p=0.79 and p=0.44, respectively). In patients from Croatian EN group Hemoglobin levels were significantly lower than levels from Bosnian EN region patients, p=0.0049. In group of patients from Bosnian EN region ureteral tumors were more frequently observed than in Croatian group of patients, when compared with renal pelvis tumors but the difference was not statistically significant (p=0.258).
Our data showed some differences in tumor localization between to investigated, relatively nearly situated, EN regions in Croatia and Bosnia. Statistically significant difference in hemoglobin levels between Croatian and Bosnian EN regions that should be further analyzed to give some reasonable explanation.
地方性肾病（EN）是一种慢性肾小管间质性肾脏疾病，与上尿路尿路上皮癌（UTUC）发病率增加相关，主要发生在多瑙河沿岸村庄的地理受限区域。基于研究结果证实，马兜铃酸是地方性肾病（EN）的致病因素。
本研究的目的是确定两个地方性流行区域UTUC的特征，并分析5年期间的趋势。
本研究纳入了克罗地亚和波斯尼亚地方性流行和非地方性流行区域所有患有UTUC且伴有或不伴有同步/异时性膀胱尿路上皮癌的患者。我们分析了2005年至2010年期间在斯拉沃尼亚布罗德的约西普·本采维奇综合医院外科和泌尿外科收治并接受手术的所有UTUC患者的档案数据库。将分析的患者组分为地方性流行组（包括来自克罗地亚和波斯尼亚地方性流行区域的患者）和非地方性流行组（包括来自克罗地亚和波斯尼亚非地方性流行区域的患者）并进行比较。所有手术标本均按照标准化病理程序进行处理。
比较克罗地亚和波斯尼亚地方性流行区域患者的基本特征，患者的性别（两个地方性流行区域女性受影响更频繁，p = 0.99）或年龄（p = 0.43）无显著差异。与波斯尼亚地方性流行区域的患者组相比，我们发现克罗地亚地方性流行区域的患者组血尿素和肌酐水平更高，但差异无统计学意义（分别为p = 0.79和p = 0.44）。克罗地亚地方性流行组患者的血红蛋白水平显著低于波斯尼亚地方性流行区域患者，p = 0.0049。与肾盂肿瘤相比，波斯尼亚地方性流行区域的患者组中输尿管肿瘤的观察频率高于克罗地亚患者组，但差异无统计学意义（p = 0.258）。
我们的数据显示，在克罗地亚和波斯尼亚两个调查的、地理位置相对较近的地方性流行区域之间，肿瘤定位存在一些差异。克罗地亚和波斯尼亚地方性流行区域之间血红蛋白水平存在统计学显著差异，应进一步分析以给出合理的解释。
