The etiology of Balkan endemic nephropathy: Still more questions than answers

Balkan endemic nephropathy (BEN) has attracted increasing attention as a po ssible environmental disease, and a significant amount of research from com plementary scientific fields has been dedicated to its etiology. There are two actual competing theories attempting to explain the cause of this kidne y disease: 1) the mycotoxin hypothesis, which considers that BEN is produce d by ochratoxin A ingested intermittently in small amounts by the individua ls in the endemic regions, and 2) the Pliocene lignite hypothesis, which pr oposes that the disease is caused by long-term exposure to polycyclic aroma tic hydrocarbons and other toxic organic compounds leaching into the well d rinking water from low rank coals underlying or proximal to the endemic set tlements. We outline the current developments and future prospects in the s tudy of BEN and differentiate possible factors and cofactors in disease eti ology.