Last September, at a hospital in eastern Croatia, my father and I visited a collection of some four hundred human kidneys. Most had belonged to the victims of a mysterious, fatal kidney disease, which occurs in agrarian communities on the Danube River and its tributaries. Some villages have it; others, seemingly identical in every way, do not. The onset of the disease, which is known as Balkan endemic nephropathy (often abbreviated as BEN), takes place in middle to later life, after the patient has lived in an affected village for fifteen or twenty years. The first symptoms include weakness, anemia, and a coppery skin discoloration. The kidneys begin to atrophy, and about half of patients also develop a rare cancer of the upper urinary tract. Without a kidney transplant or treatment by dialysis, death usually occurs within a year.
At the kidney collection, a pathologist took several formalin-filled jars out of a cabinet and lined them up on the counter. Inside were kidneys riddled with holes, misshapen kidneys with visible tumors, biopsied kidneys sliced in half, and atrophied kidneys, ghostly pale, some as small as walnuts. My father, a nephrologist, says that he has never seen kidneys as tiny as those removed from BEN patients.
BEN was first described in the nineteen-fifties. Over the years, many theories have been proposed to explain the disease, from cadmium poisoning and hantaviruses to toxic molds and chromosomal mutation. Uncertainty and controversy surround the most basic data, such as the number of people with the disease. One doctor I spoke to puts the figure at a hundred thousand. A recent Croatian study found that the incidence of the disease is declining, while a Serbian study found that it isn’t. . . .
