Nitrogen species in drinking water indicate potential exposure pathway for Balkan Endemic Nephropathy

• Published in: Environmental pollution (1987) Vol. 134; no. 2; pp. 229 - 237
• Main Authors: Niagolova, Nedialka, McElmurry, Shawn P., Voice, Thomas C., Long, David T., Petropoulos, Evangelos A., Havezov, Ivan, Chou, Karen, Ganev, Varban
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2005; Elsevier
• Subjects: Ammonia - adverse effects; Ammonia - analysis; anthropogenic activities; Balkan Endemic Nephropathy; Balkan Nephropathy - etiology; Biological and medical sciences; Bulgaria; Chlorides - analysis; Drinking; Drinking water; Endemic Diseases; Environmental Exposure - adverse effects; Exposure; Food toxicology; Humans; Medical sciences; Nitrates - adverse effects; Nitrates - analysis; Nitrites - adverse effects; Nitrites - analysis; Nitrogen; Nitrogen - adverse effects; Nitrogen - analysis; Potassium - analysis; Rural Health; Sodium - analysis; Toxicology; Water - chemistry; Water Pollutants, Chemical - adverse effects; Water Pollutants, Chemical - analysis; water pollution; water quality; Water Supply - analysis; wells; Bulgaria; Europe; Drinking water; Balkan Endemic Nephropathy; Exposure; Bulgaria; Nitrogen; Interstitial nephritis; Kidney disease; Human; Urinary system disease; Toxicity; Nitrites; Nitrogen compounds; Nitrates; Balkans endemic nephropathy; Etiology; Water pollution; Public health
• ISSN: 0269-7491; 1873-6424
• DOI: 10.1016/j.envpol.2004.08.003

This study explored two hypotheses relating elevated concentrations of nitrogen species in drinking water and the disease Balkan Endemic Nephropathy (BEN). Drinking water samples were collected from a variety of water supplies in both endemic and non-endemic villages in the Vratza and Montana districts of Bulgaria. The majority of well water samples exceeded US drinking water standards for nitrate + nitrite. No statistically significant difference was observed for any of the nitrogen species between villages classified as endemic and non-endemic. Other constituents (sodium, potassium and chloride) known to be indicators of anthropogenic pollution were also found at elevated concentrations and all followed the order wells > springs > taps. This ordering coincides with the proximity of human influences to the water sources. Our results clearly establish an exposure pathway between anthropogenic activity and drinking water supplies, suggesting that the causative agent for BEN could result from surface contamination. Water in villages affected and unaffected by Balkan Endemic Nephropathy had no significant differences in nitrogen compounds.