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中美洲肾病

Authors
Carl-Gustaf Elinder, MD, PhD
Annika O Wernerson, MD, PhD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
吴镝, 主任医师，教授

引言

中美洲肾病(Mesoamerican nephropathy, MeN)，以前被称为病因不明慢性肾病(chronic kidney disease of unknown cause, CKDu)[1]，指一种发生于中美洲年轻农业从业者中的无任何明确病因的慢性肾脏病(chronic kidney disease, CKD)[2-5]。目前，除了针对其他原因导致的非蛋白尿性CKD，并没有针对MeN的特定治疗。

本专题将总结MeN，CKD的治疗将在别处讨论。 (参见“成人慢性肾脏病治疗概述”)

流行病学

MeN该疾病的首次提出是在一项来自萨尔瓦多的研究中，该研究发现在萨尔瓦多开始透析的患者中有较大比例患者的CKD病因不明[6,7]。一项医院研究显示，在1999-2000年间开始透析的205例患者中，135例患者的终末期肾病(end-stage renal disease, ESRD)病因不明[6]。

一些随后发布的研究显示，在萨尔瓦多和尼加拉瓜的某些地区以及危地马拉及哥斯达黎加，病因不明的CKD患病率较高[4,8]：

●在一项纳入291例来自萨尔瓦多沿海地区男性的研究中，既往未诊断的CKD(定义为肌酐≥1.5mg/dL)的患病率为13%[9]。而在这些患者中，仅有38%存在糖尿病或高血压，这些为其他地区CKD的常见病因；而其余患者似乎并没有引起CKD的明确病因。相比之下，在美国，CKD的患病率约为5%[10]。 (参见“慢性肾脏病的流行病学”)

          

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-27.
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References
Top
  1. Brooks DR, Ramirez-Rubio O, Amador JJ. CKD in Central America: a hot issue. Am J Kidney Dis 2012; 59:481.
  2. Wesseling C, Crowe J, Hogstedt C, et al. Mesoamerican Nephropathy: Report from the First International Research Workshop on MeN. Central American Institute for Studies on Toxic Substances (IRET-UNA), Program on Work, Environment and Health in Central American (SALTRA), San Jose, PR 2013. p. 239.
  3. Wesseling C, Crowe J, Hogstedt C, et al. Resolving the enigma of the mesoamerican nephropathy: a research workshop summary. Am J Kidney Dis 2014; 63:396.
  4. Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis 2014; 63:506.
  5. Martín-Cleary C, Ortiz A. CKD hotspots around the world: where, why and what the lessons are. A CKJ review series. Clin Kidney J 2014; 7:519.
  6. Trabanino RG, Aguilar R, Silva CR, et al. [End-stage renal disease among patients in a referral hospital in El Salvador]. Rev Panam Salud Publica 2002; 12:202.
  7. Cuadra SN, Jakobssson K, Hogstedt C, et al. Chronic kidney disease in Central America: Assessment of current knowledge and feasibility for regional research collaboration in Central America. SALTRA Technical Series on Work & Health 2. Heredia, Costa Rica 2009. p. 73.
  8. Laux TS, Barnoya J, Guerrero DR, Rothstein M. Dialysis enrollment patterns in Guatemala: evidence of the chronic kidney disease of non-traditional causes epidemic in Mesoamerica. BMC Nephrol 2015; 16:54.
  9. Gracia-Trabanino R, Domínguez J, Jansà JM, Oliver A. [Proteinuria and chronic renal failure in the coast of El Salvador: detection with low cost methods and associated factors]. Nefrologia 2005; 25:31.
  10. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007; 298:2038.
  11. Orantes CM, Herrera R, Almaguer M, et al. Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009. MEDICC Rev 2011; 13:14.
  12. Orantes CM, Herrera R, Almaguer M, et al. Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities. MEDICC Rev 2014; 16:23.
  13. Raines N, González M, Wyatt C, et al. Risk factors for reduced glomerular filtration rate in a Nicaraguan community affected by Mesoamerican nephropathy. MEDICC Rev 2014; 16:16.
  14. O'Donnell JK, Tobey M, Weiner DE, et al. Prevalence of and risk factors for chronic kidney disease in rural Nicaragua. Nephrol Dial Transplant 2011; 26:2798.
  15. Ordunez P, Martinez R, Reveiz L, et al. Chronic kidney disease epidemic in Central America: urgent public health action is needed amid causal uncertainty. PLoS Negl Trop Dis 2014; 8:e3019.
  16. Wesseling C, van Wendel de Joode B, Crowe J, et al. Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica. Occup Environ Med 2015; 72:714.
  17. Peraza S, Wesseling C, Aragon A, et al. Decreased kidney function among agricultural workers in El Salvador. Am J Kidney Dis 2012; 59:531.
  18. Torres C, Aragón A, González M, et al. Decreased kidney function of unknown cause in Nicaragua: a community-based survey. Am J Kidney Dis 2010; 55:485.
  19. Wanigasuriya KP, Peiris-John RJ, Wickremasinghe R, Hittarage A. Chronic renal failure in North Central Province of Sri Lanka: an environmentally induced disease. Trans R Soc Trop Med Hyg 2007; 101:1013.
  20. Athuraliya NT, Abeysekera TD, Amerasinghe PH, et al. Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int 2011; 80:1212.
  21. Almaguer M, Herrera R, Orantes CM. Chronic kidney disease of unknown etiology in agricultural communities. MEDICC Rev 2014; 16:9.
  22. VanDervort DR, López DL, Orantes CM, Rodríguez DS. Spatial distribution of unspecified chronic kidney disease in El Salvador by crop area cultivated and ambient temperature. MEDICC Rev 2014; 16:31.
  23. Vela XF, Henríquez DO, Zelaya SM, et al. Chronic kidney disease and associated risk factors in two Salvadoran farming communities, 2012. MEDICC Rev 2014; 16:55.
  24. Lebov JF, Valladares E, Peña R, et al. A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis 2015; 2:6.
  25. Laws RL, Brooks DR, Amador JJ, et al. Changes in kidney function among Nicaraguan sugarcane workers. Int J Occup Environ Health 2015; 21:241.
  26. Sanoff SL, Callejas L, Alonso CD, et al. Positive association of renal insufficiency with agriculture employment and unregulated alcohol consumption in Nicaragua. Ren Fail 2010; 32:766.
  27. Laux TS, Bert PJ, Barreto Ruiz GM, et al. Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village. J Nephrol 2012; 25:533.
  28. Wesseling C, van Wendel de Joode B, Ruepert C, et al. Paraquat in developing countries. Int J Occup Environ Health 2001; 7:275.
  29. D'Haese PC, Elsevier MM, Yaqoob M, De Broe M. Organic solvents, silicon-containing compounds and pesticides. In: Clinical Nephrotoxins. Renal Injury from Drugs and Chemicals, De Broe ME, Porter GA. (Eds), Springer, New York 2008. p.827.
  30. Crowe J, Wesseling C, Solano BR, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med 2013; 56:1157.
  31. Bedford M, Farmer C, Levin A, et al. Acute kidney injury and CKD: chicken or egg? Am J Kidney Dis 2012; 59:485.
  32. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012; 82:516.
  33. Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int 2015; 87:792.
  34. Wijkström J, Leiva R, Elinder CG, et al. Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America. Am J Kidney Dis 2013; 62:908.
  35. Robey RB. Cyclical dehydration-induced renal injury and Mesoamerican nephropathy: as sweet by any other name? Kidney Int 2014; 86:226.
  36. Roncal Jimenez CA, Ishimoto T, Lanaspa MA, et al. Fructokinase activity mediates dehydration-induced renal injury. Kidney Int 2014; 86:294.
  37. Herrera R, Orantes CM, Almaguer M, et al. Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities. MEDICC Rev 2014; 16:39.
  38. Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med 2015; 58:541.
  39. Ramirez-Rubio O, Brooks DR, Amador JJ, et al. Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists. BMC Public Health 2013; 13:350.
  40. Wernerson A., Wijkström J, Gonzalez M, et al. Confirmation of renal morphology in Mesoamerican Nephropathy - A kidney biopsy study of sugar cane workers in Nicaragua. ISN World Congress of Nephrology. Cape Town, 2015. ISN: SUN-476
  41. López-Marín L, Chávez Y, García XA, et al. Histopathology of chronic kidney disease of unknown etiology in Salvadoran agricultural communities. MEDICC Rev 2014; 16:49.
  42. Wernerson A, Wijkström J, Elinder CG. Update on endemic nephropathies. Curr Opin Nephrol Hypertens 2014; 23:232.
  43. Johnson RJ, Rodriguez-Iturbe B, Roncal-Jimenez C, et al. Hyperosmolarity drives hypertension and CKD--water and salt revisited. Nat Rev Nephrol 2014; 10:415.
  44. Ramirez-Rubio O, McClean MD, Amador JJ, Brooks DR. An epidemic of chronic kidney disease in Central America: an overview. J Epidemiol Community Health 2013; 67:1.