Epidemiological characteristics Residence in an endemic settlement Family history of renal disease and of renal deaths Family history of urothelial tumours Occupational history of farming Clinical characteristics Slowly progressive renal insuffi ciency

This review addresses the unresolved aetiology of several nephropathies and associated upper tract tumours diagnosed all over the world, but especially in the Balkan regions. Studies conducted over the last 35 years point to mycotoxins, mainly ochratoxin A (OTA) as the main culprit. Recent theories however have implicated aristolochic acids (AA). The aim of this review is to put forward arguments in favour of the mycotoxin theory and to show the incoherence of the AA theory. It discusses the differences between the epidemiology of Balkan endemic nephropathy (BEN) and aristolochic acid nephropathy (AAN); OTA and AA carcinogenicity; clinical and pathological effects induced by OTA and AA; sources of OTA contamination (food, air, drinking water); OTAand AA-DNA adduct formation; the role of genetic polymorphisms ; and the risk for young children.

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