The neutron dose equivalent rate measurements by R3DR/R2 spectrometers on the international space station.

The data from two Bulgarian-German instruments with the basic name "Radiation Risk Radiometer-Dosimeter" (R3D) are discussed. The R3DR instrument worked inside the ESA EXPOSE-R facility (2009-2010), while R3DR2 worked inside the ESA EXPOSE-R2 facility (2014-2016). Both were outside the Russian Zvezda module on the International Space Station (ISS). The data from both instruments were used for calculation of the neutron dose equivalent rate. Similar data, obtained by the Russian "BTNNEUTRON" instrument on the ISS are used to benchmark the R3DR/R2 neutron dose equivalent rate. The analisys reveals that the "BTNNEUTRON" and R3DR/R2 values are comparable both in the equatorial and in the South Atlantic Anomaly (SAA) regions. The R3DR/R2 values are smaller than the "BTNNEUTRON" values in the high latitude regions. The comparison with the Monte Carlo simulations of the secondary galactic cosmic rays (GCR) neutron ambient dose equivalent rates (El-Jaby and Richardson, 2015, 2016) also shows a good coincidence with the R3DR/R2 spectrometer data obtained in the equatorial and high latitude regions.

Solar modulation of the GCR flux and dose rate, observed in space between 1991 and 2019.

The paper presents the solar modulation of the long-term galactic cosmic rays (GCR) flux and dose rates variations, observed during 14 space experiments by 10 Bulgarian build Liulin-type spectrometers (LTS) (Dachev et al., 2015a). They worked in near Earth space and in the interplanetary radiation environment between January 1991 and January 2019. Data were collected by LTS in the low Earth orbit (LEO) in the L range between 4 and 6.2 or outside the magnetosphere. The major advantage of the data sets are that they are obtained by the electronically identical LTS. The Liulin measurements of about monthly averaged flux and dose rate data are compared with the monthly values of the modulation parameter, reconstructed from the ground based cosmic ray data (Usoskin et al., 2017). A good correlation between the two data sets is observed. The most important achievement of the paper is that for the first time a proof of the solar modulation of the long-term variations of the monthly averaged dose rates is obtained. These long-term experimentally obtained dose rate data could be used for modeling of the GCR space radiation risks to humans in the near Earth radiation environment. Parallel to the long-term dose rate varitions, the monthly averaged flux variations are also presented.

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS).

BACKGROUND: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

Clinicopathological prognostic factors for upper tract urothelial carcinoma.

INTRODUCTION: The aim of the present study was to evaluate the influence of clinicopathological factors including age, gender, tumor grade, tumor stage, lymphovascular invasion (LVI), tumor necrosis and previous history of non-muscle invasive bladder cancer on outcomes of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIAL AND METHODS: A total of 60 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma at our institute between 2005 to 2012 were included in our study. Univariate and multivariate analysis was performed using the Kaplan-Meier method, log rank statistics, the chi-square test and Cox regression models. RESULTS: The mean length of follow-up time was 33.3 months. There were 27 (45%) patients alive with the disease, whereas 33 (55%) were dead. In 19 cases (31.7%) the tumor grade was low, while in 41 cases (68.3%) it was high. Lymphovascular invasion was observed in 28 (46.7%) cases. Tumor necrosis was registered in 14 patients (23.3%). From the patients with LVI, 3 (9.6%) were alive, whereas from the patients negative for LVI, 75% were alive. Significant relationship was found between gender and grading and between positive LVI and low grading. CONCLUSIONS: Day case Variables such as gender, grading, tumor stage, LVI and tumor necrosis were all demonstrated to be significant independent prognostic factors for the overall survival. On the multivariate analysis only LVI remained statistically significant, which may explain the different clinical course in patients and could be considered as a part of pathological reporting and treatment planning for the future.

Prevalence of and potential influencing factors for alcohol dependence in Europe.

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.

Incidence and predictive factors of Balkan endemic nephropathy: a longitudinal study.

Balkan endemic nephropathy (BEN) is a chronic kidney disease that progresses slowly. There are no known clinical markers to identify an early disease development. We evaluated the relationship between parental history of BEN and clinical markers as predictors of new occurrences of BEN. A 5-year prospective study in the offsprings of BEN and control patients was conducted in Vratza, Bulgaria, between 2003 and 2009 using markers in years one and three to predict new cases of BEN in the year five. We defined incident cases of BEN based on parental history, reduced kidney size and reduced kidney function, distinguishing probable and definite BEN, both combined as total incidence. The data were analyzed by Cox regression models using age as time scale and controlling for gender. We estimated hazard ratios and their 95% confidence intervals. The incidence of BEN was 17.4%. Paternal history was strongly associated with all three incidence groups (hazards ratio: 27-68, P <0.05). A reduction of kidney size of 1 mm resulted in a 5% increased hazard. However, taking parental history of BEN into account, these associations lost their significance. No kidney function measures were associated with new onset of BEN. A parental history of BEN is more important than clinical markers predicting the incidence of BEN. Without this information, kidney length forecasts probable BEN and the total incidence, while none of any clinical markers was related to definite BEN.

Consensus statement on screening, diagnosis, classification and treatment of endemic (Balkan) nephropathy.

Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers.

Whole genome methylation array analysis reveals new aspects in Balkan endemic nephropathy etiology.

BACKGROUND: Balkan endemic nephropathy (BEN) represents a chronic progressive interstitial nephritis in striking correlation with uroepithelial tumours of the upper urinary tract. The disease has endemic distribution in the Danube river regions in several Balkan countries.DNA methylation is a primary epigenetic modification that is involved in major processes such as cancer, genomic imprinting, gene silencing, etc. The significance of CpG island methylation status in normal development, cell differentiation and gene expression is widely recognized, although still stays poorly understood. METHODS: We performed whole genome DNA methylation array analysis on DNA pool samples from peripheral blood from 159 affected individuals and 170 healthy individuals. This technique allowed us to determine the methylation status of 27 627 CpG islands throughout the whole genome in healthy controls and BEN patients. Thus we obtained the methylation profile of BEN patients from Bulgarian and Serbian endemic regions. RESULTS: Using specifically developed software we compared the methylation profiles of BEN patients and corresponding controls and revealed the differently methylated regions. We then compared the DMRs between all patient-control pairs to determine common changes in the epigenetic profiles.SEC61G, IL17RA, HDAC11 proved to be differently methylated throughout all patient-control pairs. The CpG islands of all 3 genes were hypomethylated compared to controls. This suggests that dysregulation of these genes involved in immunological response could be a common mechanism in BEN pathogenesis in both endemic regions and in both genders. CONCLUSION: Our data propose a new hypothesis that immunologic dysregulation has a place in BEN etiopathogenesis.

The role of a parental history of Balkan endemic nephropathy in the occurrence of BEN: a prospective study.

Balkan endemic nephropathy (BEN) is a chronic kidney disease that affects persons living in the Balkans. Despite the unique geographical specificity of this disease, its etiology has remained unclear. Even if a positive family history of BEN has been identified, it is still uncertain how the disease develops in offspring. In this paper, we examine clinical mechanisms related to the onset of BEN in individuals who have a parental history of BEN to identify early detection of the disease and formulate interventions. We conducted a 5-year prospective study, using markers in years one and three to predict new cases of BEN in year five. New cases of BEN were defined based on three criteria: parental history of BEN, reduced kidney size, and reduced kidney function. Incident cases were divided into (1) probable, (2) definite, and (3) combined labeled total incidence. We evaluated parental history in relation to BEN and tested the potentially intervening effects of kidney length, kidney cortex width, ß(2)-microglobulin, C-reactive protein, and creatinine clearance, using path analyses. The findings of the path analyses suggested that parental history of BEN had both direct and indirect effects. The direct effect was significant for all three modes of parental history (biparental, maternal, and paternal; odds ratios 71.5, 52.3, and 50.1, respectively). The indirect effects of maternal BEN acted via kidney length and creatinine clearance. Biparental BEN was mediated by (1) kidney length and creatinine clearance, and (2) creatinine clearance alone. Paternal BEN had three indirect effects: (1) through kidney length and creatinine clearance, (2) via kidney cortex width and creatinine clearance, and (3) via kidney cortex width only. In conclusion, a family history of BEN led to reduced kidney length and cortex width, and a decline in creatinine clearance, which in turn predicted the onset of BEN.

Efficacy of tamsulosin oral controlled absorption system after extracorporeal shock wave lithotripsy to treat urolithiasis.

OBJECTIVE: To determine the efficacy of the tamsulosin oral controlled absorption system as an adjuvant therapy to extracorporeal shock wave lithotripsy (ESWL) for the expulsion of ureteral and renal stones. METHODS: A consecutive sample of 248 patients with ureteral or renal stones who underwent ESWL in an academic hospital was included in a 12-week, prospective, open-label, randomized clinical trial. Of the 248 patients, 186, including 77 with ureteral stones (mean size 9 mm) and 109 with renal stones (mean size 13 mm) completed the study. After successful ESWL, the patients were randomized to standard medical care (corticosteroids and analgesics) or standard care plus the tamsulosin oral controlled absorption system 0.4 mg/d for 1 month. The stone clearance rate, interval to the elimination of stone fragments, incidence of renal colic, and the need for rehospitalization were assessed at 4, 8, and 12 weeks. RESULTS: The stone clearance rate was significantly greater for the patients treated with tamsulosin than for those in the standard care group at 4 (73.4% vs 55.9%, respectively; P < .001) and 12 (91.3% vs 74.6%, respectively; P < .05) weeks. Tamsulosin treatment was also associated with a significantly lower interval to the elimination of stone fragments (P < .001), a significantly lower rehospitalization rate (P < .001), and a significantly lower proportion of patients with acute renal colic (P < .05) than standard care alone. No severe adverse events leading to treatment discontinuation were observed. CONCLUSION: Adjuvant treatment with tamsulosin, in addition to standard treatment with steroids and analgesics, improved the outcome of ESWL.

The global availability of n-3 fatty acids.

OBJECTIVES: To assess the validity of FAO data on the availability of fish and vegetable oils as an indicator of national n-3 fatty acid (FA) intake and to estimate the worldwide population living in countries with low n-3 FA intake. DESIGN: Levels of the essential FA α-linolenic acid (ALA) and DHA, measured by GC in adipose tissue from participants in the present study and from published studies in eleven other countries, were used to validate ALA and fish availability estimated from FAO food balance sheets. On the basis of the validated FAO data for ALA and fish availability, we estimated the global prevalence of low n-3 FA availability. SETTING: Rural and urban areas of Bulgaria. SUBJECTS: Fifty men and fifty-eight women. RESULTS: Adipose tissue ALA and DHA levels (0·34 % and 0·11 % of total FA, respectively) in Bulgaria were lower than those of the eleven other countries with available data. A strong positive correlation was found between adipose tissue DHA and fish availability (r = 0·88) and between adipose tissue ALA and ALA availability (r = 0·92). Approximately half of the world's population lived in middle- and low-income countries with limited access to n-3 FA (fish < 400 g/week and ALA < 4 % of total vegetable oils), with the largest proportion being in South-East Asia (53·6 %), followed by Africa (27·1 %) and Eastern Europe (8·5 %). Of this half, 33 % lived in countries such as Bulgaria where n-3 FA was almost unavailable (fish < 200 g/week and ALA < 2 % of total vegetable oils). CONCLUSIONS: Very low availability of n-3 FA is extensive worldwide.

Reduced kidney size in adult offspring of Balkan endemic nephropathy patients and controls: a prospective study.

INTRODUCTION: Reduced kidney size has been proposed as a criterion for clinical diagnosis of Balkan endemic nephropathy (BEN). Some studies suggest that smaller kidneys are found in advanced stages of BEN, whereas others reported them in earlier stages. To investigate the clinical course of kidney sizes in the offspring of BEN and non-BEN parents, we followed up a cohort of adult offspring over 5 years. We hypothesized that parental history affects kidney dimensions. METHODS: Four repeated ultrasound measurements of kidney length and cortex width were conducted in 121 offspring of BEN and 98 offspring of non-BEN parents. Repeated measurements were analyzed using mixed models adjusting for gender and time-dependent information on other kidney diseases, diabetes, age, height and year of follow-up. RESULTS: A reduction of kidney length was associated with maternal BEN (-4 mm, P = 0.001). We detected a parallel decline in kidney length in the various offspring groups. However, kidney cortex width was significantly smaller when both parents or the mother had BEN and offspring age > or =60 years (-1.88 mm, P = 0.0003; -1.03 mm, P = 0.05). In the 5th year of follow-up, 37 participants developed BEN (14 confirmed, 23 suspected). Kidney cortex width at baseline was smaller in offspring who developed BEN (P = 0.0001). CONCLUSIONS: The development of kidney dimensions depends on the parental BEN status and offspring age. In BEN offspring, ultrasound measurements of the kidney cortex width seem to have a prognostic value.

Ochratoxin A and ß2-microglobulin in BEN patients and controls.

Ochratoxin A (OTA) is a mycotoxin naturally occurring in different foods. OTA is arguably a risk factor for Balkan endemic nephropathy (BEN). The aims of this study are to (1) test the OTA-BEN association in BEN-groups and controls and (2) determine whether urine ß2-microglobulin, a marker of impaired ability of the kidneys to re-absorb, is related to OTA. BEN patients had significantly higher OTA serum levels. Within the offspring, OTA was significantly related to higher ß2-microglobulin excretion. OTA (2005/2006) was related to a higher incidence of BEN after 2008, providing further evidence that OTA is a risk factor for BEN.

Offspring of parents with Balkan Endemic Nephropathy have higher C-reactive protein levels suggestive of inflammatory processes: a longitudinal study.

BACKGROUND: Despite the characteristic extensive tubulointerstitial fibrosis, Balkan Endemic Nephropathy (BEN) is usually considered a non-inflammatory disease. METHODS: We examined a marker of inflammation, C-reactive protein (CRP), in the offspring of patients with BEN, a population at risk for BEN, prior to development of established disease to determine if an inflammatory process could be identified in the early stages of the disease. In 2003/04, 102 adult offspring whose parents had BEN and a control group of 99 adult offspring of non-BEN patients were enrolled in this prospective study. This cohort was re-examined yearly for four consecutive years. Levels of serum CRP were measured in years 3 and 4 and compared between groups. The data were analyzed with mixed models. RESULTS: Compared to controls, offspring of BEN parents had statistically higher CRP levels in two consecutive years, suggestive of early inflammatory reactivity. Whenever the mother was affected by BEN (both parents, or mother only), serum CRP was significantly increased, but not if only the father had BEN. CRP was inversely related to kidney cortex width but not to markers or renal function. CONCLUSION: Early stages of BEN may involve inflammatory processes. The observation of a maternal involvement supports the concept of fetal programming, which has been implicated in the pathogenesis of other chronic kidney diseases.

Cardiovascular risk assessment of Bulgarian urban population: cross-sectional study.

AIM: To assess the total cardiovascular risk of the Bulgarian urban population. METHODS: A representative sample of Bulgarian urban population (n=3810, response rate 68.3%) from five Bulgarian cities was included in a cross-sectional observation study performed in the period 2005-2007. A detailed cardiovascular risk assessment was performed by general practitioners and a total 10-year risk of a fatal cardiovascular event was estimated according to the European Systematic Coronary Risk Evaluation (SCORE, HeartScore. RESULTS: There were 48.7% of participants in the high risk group (SCORE > or =5%), 24.3% aged 45-54 and more than half aged 55-64 years. Nearly a quarter of the sample had a total cardiovascular risk of over 10% (SCORE > or =10%), whereas 10.1% of the sample had excessively high cardiovascular risk (SCORE > or =15%). In the 65-75 age group, the prevalence of men with excessively high risk was 46.6%, compared with 6.0% in women (P<0.001). Most of the main cardiovascular risk factors were slightly increased or borderline in comparison with clinical thresholds. CONCLUSIONS: Cardiovascular risk is high in a large proportion of Bulgarian urban population, especially in men aged over 65. These findings indicate that a comprehensive national strategy and program for management of cardiovascular diseases is urgently needed. The SCORE method can be well implemented if a higher threshold for a high risk group is defined and smaller target population is planned for extensive and expensive high risk preventive measures.

Prevalence of obesity and overweight among urban adults in Bulgaria.

OBJECTIVE: The prevalence of obesity is increasing in transitional countries, but extensive data on some countries, such as Bulgaria, are still lacking. Therefore, the objective of the present study was to estimate the prevalence of overweight and obesity, relative to gender and income, among adults in Sofia, Bulgaria. DESIGN: Cross-sectional survey to collect data on diet, health, BMI and income using a brief questionnaire on diet and income. Data were analysed using analysis of covariance to determine differences within and between income and gender groups. SETTING: Sofia, Bulgaria. SUBJECTS: Adults living in the city of Sofia, Bulgaria. RESULTS: For adults 30-60 years of age, 35.1 % were overweight and 6.2 % were obese. The proportion of overweight and obesity was higher among men than women (44.8 % v. 32.4 % and 6.0 % v. 4.7 %, respectively). With respect to income, BMI decreased as income increased. For men, BMI was highest for the lowest and highest income groups, whereas for women lower income was associated with a higher BMI. CONCLUSION: The prevalence of overweight and obesity appears to be an emerging problem in some sectors of Bulgarian society, based on our data from the largest urban area of the country. These data provide new information on the divergence in health and disease risk in a country that is still economically challenged and may be facing the nutrition transition.

Metals and kidney markers in adult offspring of endemic nephropathy patients and controls: a two-year follow-up study.

BACKGROUND: The etiology of Balkan Endemic Nephropathy, (BEN), a tubulointerstitial kidney disease, is unknown. Although this disease is endemic in rural areas of Bosnia, Bulgaria, Croatia, Romania, and Serbia, similar manifestations are reported to occur in other regions, for instance Tunisia and Sri Lanka. A number of explanations have been stated including lignites, aristolochic acid, ochratoxin A, metals, and metalloids. Etiologic claims are often based on one or a few studies without sound scientific evidence. In this systematic study, we tested whether exposures to metals (cadmium and lead) and metalloids (arsenic and selenium) are related to Balkan Endemic Nephropathy. METHODS: In 2003/04 we recruited 102 adults whose parents had BEN and who resided in one of three communities (Vratza, Bistretz, or Beli Izvor, Bulgaria). A control group comprised of 99 adults having non-BEN hospitalized parents was enrolled in the study during the same time. We conducted face-to-face interviews, ultrasound kidney measurements, and determined kidney function in two consecutive investigations (2003/04 and 2004/05). Metals and metalloids were measured in urine and blood samples. To assess the agreement between these consecutive measurements, we calculated intraclass correlation coefficients. Repeated measurement data were analyzed using mixed models. RESULTS: We found that cadmium and arsenic were associated with neither kidney size nor function. Lead had a significant but negligible effect on creatinine clearance. Selenium showed a weak but significant negative association with two of the four kidney parameters, namely creatinine clearance and beta2-microglobulin. It was positively related to kidney length. These associations were not restricted to the offspring of BEN patients. Adding credence to these findings are reports showing comparable kidney effects in animals exposed to selenium. CONCLUSION: The findings of this 2-year follow-up study indicate that metals and metalloids do not play a role in the etiology of Balkan Endemic Nephropathy. Against the assumption in the literature, selenium was not protective but a risk factor. Since comparable associations were observed in animals, future studies are needed to explore whether selenium may have adverse renal effects in humans.

Critical evaluation of environmental exposure agents suspected in the etiology of Balkan endemic nephropathy.

Balkan endemic nephropathy (BEN), a kidney disease that occurs in rural villages in Bosnia, Bulgaria, Croatia, Romania, and Serbia, is thought to be linked to an environmental toxin. The authors review literature on proposed environmental exposure agents, report the results of field sampling and analysis studies to evaluate potentials for exposure to proposed agents, and propose criteria for future testing. They used these criteria to evaluate the evidence for suggested hypotheses, concluding that several proposed agents can be eliminated or considered unlikely based on apparent inconsistencies between clinical or epidemiologic evidence related to BEN and toxicologic or exposure evidence related to the agents. Mycotoxins and aristolochic acid are the primary targets of current toxicologic investigations, and while the evidence on exposures for both is potentially consistent, it is insufficient.

Economic transition and household food consumption: a study of Bulgaria from 1985 to 2002.

Major economic transitions typically entail changes in the availability of and purchasing power for different types of foods leading to long-term changes in the composition of the diet. Bulgaria, a former Eastern Bloc country, underwent a difficult and protracted transition from a centralized to market economy with acute economic crises and a much slower recovery of income levels than in Poland, the Czech Republic, and Hungary. Using annual data from the Bulgarian National Household Survey, we study changes in the reported consumption of major foods (excluding alcoholic drinks) and their constituent macronutrients from 1985 to 2002, examining also the differences in dietary patterns between the period prior to and following the transition. The consumption of most major food items decreased, resulting in a fall in per capita energy consumption of 429 kcal/day (1.80 MJ/d), following the economic transition of 1991. As expected, the consumption of foods that were more expensive per unit of energy decreased greater than cheaper foods, -34% for animal products and -19% for visible fats, but only -10% for carbohydrates. These changes are related to the changes in income and market prices as well as the general negative trend in economic growth and hyperinflation in the mid-1990s. Thus, Bulgaria experienced a decrease in food consumption without significant changes in the dietary pattern following the economic transition of 1991. The fact that part of this decline may be attributed to continued economic challenges suggests that future transitions in the diet may be expected as economic development proceeds.

Increased blood pressure in adult offspring of families with Balkan endemic nephropathy: a prospective study.

BACKGROUND: Previous studies have linked smaller kidney dimensions to increased blood pressure. However, patients with Balkan Endemic Nephropathy (BEN), whose kidneys shrink during the course of the disease, do not manifest increased blood pressure. The authors evaluated the relationship between kidney cortex width, kidney length, and blood pressure in the offspring of BEN patients and controls. METHODS: 102 offspring of BEN patients and 99 control offspring of non-BEN hospital patients in the Vratza District, Bulgaria, were enrolled in a prospective study and examined twice (2003/04 and 2004/05). Kidney dimensions were determined using ultrasound, blood pressure was measured, and medical information was collected. The parental disease of BEN was categorized into three groups: mother, father, or both parents. Repeated measurements were analyzed with mixed regression models. RESULTS: In all participants, a decrease in minimal kidney cortex width of 1 mm was related to an increase in systolic blood pressure of 1.4 mm Hg (p = 0.005). There was no association between kidney length and blood pressure. A maternal history of BEN was associated with an increase in systolic blood pressure of 6.7 mm Hg (p = 0.03); paternal BEN, +3.2 mm Hg (p = 0.35); or both parents affected, +9.9 mm Hg (p = 0.002). There was a similar relation of kidney cortex width and parental history of BEN with pulse pressure; however, no association with diastolic blood pressure was found. CONCLUSION: In BEN and control offspring, a smaller kidney cortex width predisposed to higher blood pressure. Unexpectedly, a maternal history of BEN was associated with average increased systolic blood pressure in offspring.