American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of cancer are patients with Balkan endemic nephropathy at increased risk for?

1. Renal cell carcinoma

2. Transitional cell carcinomas

3. Urothelial carcinoma

4. Bladder adenocarcinoma

The correct answer is: Transitional cell carcinomas

Patients with Balkan endemic nephropathy are at increased risk for transitional cell carcinomas, particularly of the bladder. This association is primarily attributed to the endemic nephropathy, which is linked to long-term exposure to certain environmental factors, such as the ingestion of specific toxins in contaminated water or food, and the resultant kidney damage. The chronic renal impairment and associated changes in the urinary tract create a favorable environment for the development of transitional cell carcinomas. Transitional cell carcinoma refers specifically to cancers that arise from the urothelium (the bladder's lining), and patients with Balkan endemic nephropathy have shown a notable increase in incidences of these cancers compared to the general population. The underlying mechanisms may involve both direct carcinogenic effects of the nephrotoxins and the secondary consequences of renal failure and altered urinary composition. Other types of cancer mentioned, such as renal cell carcinoma and bladder adenocarcinoma, do not have the same established connection with Balkan endemic nephropathy, indicating the unique risk association of transitional cell carcinomas in this patient population.