Several criteria are necessary to meet in order to have the diagnosis of Balkan endemic nephropathy established. One of them is tubular proteinuria type that may be found, but not in the early stage of the disease. Beta 2 microglobulin may be found in the early stage, but its determination is rather cumbersome and not suitable for a daily routine. Therefore, urinary albumin/creatinine ratio was determined in 8 patients (all females, aged 58,37±4,37 years) from the town of aamac region (Bosnia and Herzegovina) as a measure of albumin excretion in order to establish useful marker in the early stage of the disease. Increased urinary albumin/creatinine ratio, was found in 50% of BEN patients. According to these preliminary results, microalbuminuria could be used as the reliable marker for the early detection of BEN.

It has been estimated that around 2.000 patients have been affected by BEN in Bosnia before the war 1992-1995 so that the need for the assessment of the current situation has emerged for the first time after a decade of BEN enigma in Bosnia. Therefore, the medical team from Tuzla University Clinical Centre Renal Unit has visited the affected municipalities and corresponding medical centers in order to make that assessment. The main results coming out of this initiative are that BEN Dispansaries, that used to function before the war, do not function nowadays at all so that fairly often new BEN cases are detected for the first time at later stages of the disease when they already require either preparation for replacement therapy or even urgent life-saving measures. It is necessary to re-establish the system of surveillance of BEN patients that existed before the war as soon as possible. Therefore, the Project Proposal has been prepared to accomplish that goal.

Renal function studies were performed on 59 patients who had the clinical criteria for Balkan endemic nephropathy (BEN). They were divided into three groups according to DTPA clearance (DTPA). Group 1, 11 individuals, had a mean age of 41.6 years and DTPA greater than 100 ml/min. Group 2, 20 persons, had a mean age of 49 years and DTPA of 60 to 100 ml/min. Group 3 was made up of 28 people with a DTPA less than 60 ml/min and an average age of 50.4 years. No distinguishing specific or characteristic symptoms of BEN were found in any of the three groups. Anemia was not found to be an early indicator when compared to other forms of progressive renal disease. Proteinuria was minimal and intermittent in all three groups. Maximum concentrating ability was significantly reduced only in the third group. These features do not allow the clinical differentiation of BEN from other chronic progress tubulointerstitial nephropathies. The geographic isolation and familial nature of the disease, associated with minimal proteinuria make BEN a unique entity. Kidney size by ultrasound was decreased in all three groups, suggesting that this may be another early and characteristic feature to BEN.