BALKAN ENDEMIC NEPHROPATHY

INTRODUCTION

Toxic organic substances leached from low-rank coal (lignite) beds into groundwater aquifers might be a cause of Balkan endemic nephropathy (BEN), a disease resulting in end-stage kidney failure that affects tens of thousands of people in rural villages of Romania, Bulgaria, Croatia, Serbia, Bosnia, and Kosovo. The causative agent of BEN may also cause cancer of the renal pelvis, which is found in about half of all patients with the disease (in contrast to this cancer's occurrence in less than 1% of the overall population).

|  | Figure 25. A typical panorama of a Balkan endemic nephropathy afflicted village from Romania. Usually the endemic villages are located in alluvial valleys of the Danube River affluents, at low elevations (valley bottoms). Danube River is located across the hills, on the right.

Figure 26. BEN occurs in foci called "endemic areas" located in alluvial valleys of tributaries of the Danube River in Bosnia, Bulgaria, Croatia, Romania, and Serbia.

|  | Figure 27. BEN patient from Southwestern Romania awaiting dialysis treatment at a clinic. BEN patients are transported every 2 to 3 days by ambulance from rural villages to clinics for treatment. Many also acquire hepatitis from overused dialysis equipment.

Figure 28. Picture of Pliocene lignite seams from a mine in the endemic area of Romania. These coals lie in the steep hills above the endemic villages and in some cases underlie the villages. |  |

|  | Figure 29. In the early 1990's USGS scientists noted the close geographic correspondence between endemic areas and Pliocene lignite beds in Yugoslavia. Map shows BEN-endemic areas in yellow and locations of Pliocene lignite beds in red (other colors represent coals of other ranks). This observation and subsequent field and laboratory investigations led USGS researchers to generate the "Pliocene lignite hypothesis" to explain the cause of BEN. VIEW a large, higher quality PDF file

Figure 30. USGS scientists taking water sample from a shallow, hand-dug well in an area of Romania endemic for BEN. Note plastic-lined amber bottles in which water samples are shipped to the USA for laboratory analysis. Solvent (3% dichloromethane) is added to the bottles to inhibit algal and microbial growth and to initiate the organic compound extraction procedure. |  |

Figure 31. Total ion current (TIC) chromatograms (generated using gas chromatography and mass spectrometry) of laboratory water extracts of Pliocene lignites from two BEN-affected areas -- Romania (A) and Serbia (B) -- and of a bituminous coal from Maryland, USA (C) as a negative control. Peaks indicate the presence of potentially toxic organic compounds. Absorbance units on y-axis indicate the relative concentrations of compounds, while retention time in minutes along the x-axis is used to identify individual compounds or classes of compounds.

Figure 32. TICs (see caption to fig. 31 for explanation) for water samples. A, Seep from a Pliocene lignite bed in a BEN-endemic area of Romania. B, Well water from an endemic village in Romania. C, Spring water from a nonendemic (control) village in Romania.

|  | Figure 33. Examples of the types of compounds tentatively identified in well water from endemic villages in Romania, and from water extracts of Pliocene lignites from the endemic region of Romania.

CONCLUSION

Emissions from industrial coal and coal product combustion in the United States do not present a significant acute threat to human health. The burning of coal in residential settings, however, has had a serious impact on human health, especially in developing countries. This is due to the improper use of coal (such as burning in unvented stoves), or the use of inappropriate coal (for example, cooking foodstuffs with arsenic-enriched coal). Coal scientists and technologists are ideally positioned to help medical and public health specialists improve health status in these countries by providing scientific research, analytical data, technical training, and modern technology such as digital maps. The information being generated may help to minimize the health impacts of coal use and help to avoid future threats to human welfare.

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