[Additional information on the history of Balkan endemic nephropathy]. / Dopulnitelni svedeniia za istoriia na balkanskta endemichna nefropatiia.

The paper presents additional information to the bibliographic check up in the two papers of Asst. Prof. Dimitrov, published in the periodical "Vutreshni bolesti" in 1982 as regards the history of Balkan endemic nephropathy, being of importance for the early history of the disease. Some of the data not accurately cited in the two papers of Asst. Prof. Dimitrov are corrected. Critical notes are also presented about the erroneous interpretation of some of the early written scientific facts.

[Possibility for studying the life expectancy of patients with Balkan endemic nephropathy by dispensary observation]. / Vuzmozhnost za prouchvane produlzhitelnostta na zhiveene na bolnite ot balkanska endemichna nefropatiia chrez dispanserno nabliudenie.

The follow-up cards of 1100 patients that died of Balkan endemic nephropathy (BEN) within the period 1962-1981 were studied with a view to establishing the incidence of the disease in Vratza district, affection of sex and age and chiefly--the duration of the disease. The authors established that the disease was found in 47 settlements of Vratza district, that the females were more often affected as compared with the males and that the subjects aged from 30 to 70 were most frequently affected. More that the half of the patients with BEN was established by the authors, to die with--in the first 5 years since the onset of the disease, whereas the rest--live longer, in single cases, over 20 years.

[Treatment of chronic renal failure by means of routine hemodialysis]. / Nashiat opit lechenieto na khronichnata bubrechna nedostatuchnost chrez programna khemodializa.

The authors share their eight-and-a half-year experience in the treatment of 136 patients with terminal chronic renal insufficiency (CRI), treated via programmed hemodialysis. The programmed hemodialysis was established to considerably prolong the lives of the patients with terminal CRI. Many of them were rehabilitated to a state, making them feel complete citizens. The authors established that the patients with Balkan endemic nephropathy, as compared with those with chronic pyelo-nephritis and glomerulonephritis were adapted and rehabilitated far faster. It was also established that the earlier the hemodialysis treatment was performed, the faster those patients were adapted and rehabilitated and the longer they lived. The effectiveness of hemodialysis therapy was negligible in patients with poor general state. According to their observations blood urea should not be higher than 180-200 mg%, creatinin--over 10-12 mg%, hematocrit--under 25% and hemoglobin under 8 g%.

[Plasma levels of follicle-stimulating and luteinizing hormones, prolactin and estradiol in women with chronic kidney failure on programmed hemodialysis]. / Plazemni niva na folikulostimulirashtiia (FSKh) i luteinizirashtiia (LKh) khormon, prolaktin (P) i estradiol (E) pri zheni s khronichna bubrechna nedostatuchnost (KhBN) na programma khemodializa.

The plasma level of FSH, LH, P and E of 24 women with CRI, aged from 16-61, on a programmed hemodialysis was determined, 13 of them with Balkan endemic nephropathy, 8--chronic pyelonephritis and one patient with chronic glomerulonephritis, polycystosis of kidneys and lupus nephritis. The patients were grouped into three groups according to age and genital cycle: with genital cycle--10, secondary amenorrhea--7, and in menopause--7. The patients with genital cycle were grouped as follows: 4 with eumenorrea, 4--opsomenorrhea and I with hyper- and I with hypomenorrhea. Plasma hormone level prior to and post hemodialysis was determined by radioimmunologic methods. The results obtained showed that FSH levels, as compared with the control group of healthy women, was unchanged, LH and P--was elevated and E was elevated only in the patients with genital cycle. No significant discrepancy was found in the levels of the hormones studied, in the three groups of females with CRI on programmed hemodialysis (with genital cycle, secondary amenorrhea and menopause), except for E in the women with cycle. The studies of the authors showed that plasma levels of FSH, LH, P and E prior to and post hemodialysis, are insignificantly changed. That provided grounds to admit that the hormones are nondialysable. The authors admit that the programmed hemodialysis is a treatment method by which the genital cycle in some CRI patients with secondary amenorrhea could be restored.

[Hypophyseal-ovarian disorders in chronic kidney failure]. / Khipofizo-ovarialni narusheniia pri bolni s khronichna bubrechna nedostatuchnost.

The authors studied the plasma level of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E) and progesterone (P) in 2 female patients with chronic renal insufficiency (ChRI), aged 21--42, without any genital ailments. The patients were conservatively treated. The authors found elevated plasma level of FSH and LH in the plasma of the female patients with ChRI and decreased E and P. The direct lesion of the hypophyseal-ovarial axis by uremic toxins is the reason, admitted by the authors for the hormonal dysbalance in the patients with ChRI. Similar changes are admitted to be found at the hypothalamus level as well. According to the authors the hormonal dysbalance in the female patients with ChRI is the cause for the grave changes observed in the genital cycle.

[Case of an immigrant with Balkan endemic nefropathy]. / Sluchai na bolen imigrant ot balkanska endemichna nefropatiia.

The author describes a female patient with Balkan endemic nephropathy (BEN) born in a non-endemic village of Sofia district, who at the age of 23, after her marriage, emigrated to an endemic village of Vratza district and after living 38 years in that village, got sick and died. The case was confirmed pathohisto-morphologically. The case is a contribution to the clinical development of BEN and solves definitely the problem that emigrants suffer that disease after a long period living in an endemic settlement.

[Medical geographical map of Balkan endemic nephropathy in Vratsa District]. / Mediko-geografska karta na balkanskata endemichna nefropatiia vuv Vrachanski okrug.

The author has studied the spread of the Balkan endemic nephropathy (BEN) according to the dispensary, clinical and post mortem data in the district of Vartza and established that the disease is met in 41 settlements of the district with a total population of 47,589. The average morbidity rate in the endemic villages is 35.9% of the population. In three villages it is over 200% in five--over 100--200% and four from 50--100%, in 25--from 2--50% and only in four villages under 2%. The author has elaborated a medico-geographical map on the base of the number of the settlements where patients with BEN are to be found. As seen from the map, the disease is met in settlements situated at the foot of the Balkan and its foothills: Vratza region of the Balkan and Veslez. It is interesting to be pointed out that certain settlements free of the disease are to be found among the endemic villages. The disease affects the village population. In the towns of Vratza and Mesdra, though situated in the center of the endemic region, no BEN patients have been found among the local population.

[Study of kidney function by radioisotopic methods in Balkan endemic nephropathy]. / Izsledvane funktsiiata na bubretsite chrez radioizotopni metodi pri bolni ot balkanska endemichna nefropatiia.

The authors studied the renal function in 80 patients with Balkan endemic nephropathy (BEN), 27 males and 53 females, aged from 29-67, by radioisotope clearance (EDTA--16 9yb and hippuran--131J) and isotope nephrogram (ING). The patients were subdivided into four groups according to the creatinine level: first group--creatinine up to 1,5 mg%, 20 patients: second group--creatinine from 1,6 to 8 mg%, 34 patients, third group--creatinine from 8,1 to 15 mg%--16 patients and in the fourth--with creatinine over 15 mg%--10 patients. The examinations revealed that radioisotope clearances, provide significant information about renal function with various stages of nitrogen decompensation. EDTA clearance, according to the authors, can detect the changes in glomerul filtration of patients with BEN at an early compensated stage. The authors compare the results obtained from the investigation of the glomerular filtration by creatinine and EDTA clearance and found the radioisotope clearance more accurate. The effective renal plasma flow in patients with BEN at the early stage of the disease, was established not to be disturbed. That provides grounds to admit that in BEN glomeruli are very likely damaged earlier as compared with the tubules. Isotope nephrogram, according to the authors, is not changed at the early BEN stages. The changes are most frequently bilateral in the advanced stages of the disease.

[Congenital anomalies of the excretory system and their relationship to endemic nephropathy]. / Vrodeni anomalii na otdelitelnata sistema i vruzkata im s endemichnata nefropatiia

The author has studied the congenital anomalies of the urogenital system according to the clinical data of the Nephrology Ward, District Hospital--Vratza, by means of urography, ascending pyelography and reno-vasography. A total of 1960 patients were examined and congenital anomalies of the urogenital system established in 167 (8, 5%). Congenital anomalies of the excretory system, according to the author, are more often met in females (59, 9%) as compated with males (40, 1%) and in left kidney (58, 6%) as compared with the right one (35, 9%). At the same time, the most frequent complication of renal embryopathies was established to be the inflammation process of urinary ducts and kidneys (41, 9%) urinary-calculus disease (19.1%) and endemic nephropathy (8, 9%). The combination of endemic nephropathy and congenital anomalies of the urogenital system is rare (1, 1%) and most likely by chance. The author admits that endemic nephropathy most probably is not causality with the congenital anomalies of the excretory system.

[Study of the distribution of kidney calculi in Vrastsa District]. / Prouchvane vurkhu razprostranenieto na bubrechnokamennata bolest vuv Vrachanski okrug

The authors have studied the RCD spread in Vratza district according to the material of the therapeutic departments in the district for the period 1969--1973 and according to the material of the out-patient department -- polyclinical--1971--1973. During that period 16,294 patients with diseases of the urinary system were registered, 6311 out of them with RCD, i. e. 38.7 per cent. The region of Mezdra was established to be the highest affected by RCD in the district (60,8%), followed by Belaslatina region (43.4%), Vratza (40%), Kneza (37.9%) and Orejahovo the last--(22.4%). Females were established to suffer more frequently (56.7%) as compared with males (43.3%) and the peasants 51.8%) insignificantly more often in comparison with the the townsmen (48.7%). All ages are affected by the disease but most frequently the individuals aged 31--50 (49.5%). Workers (36.4%) are those that most frquently suffer of RCD in the district of Vratza, followed by employees (23.4%), cooperative farmers (21.6%), etc. The authors have established that renal calculosis affects most frequently the right kidney (56.6%) as compared with the left (40.4%) and very rarely both kidneys (2.94).