- Carl-Gustaf Elinder, MD, PhD
Carl-Gustaf Elinder, MD, PhD
- Professor and Senior Consultant of Renal Medicine
- Karolinska Institute, Sweden
- Annika O Wernerson, MD, PhD
Annika O Wernerson, MD, PhD
- Professor and Senior Consultant in Pathology
- Karolinska Institute, Sweden
Mesoamerican nephropathy (MeN), formerly called chronic kidney disease of unknown cause (CKDu) , refers to CKD that presents in young, agricultural workers in Central America in the absence of any clear etiology [2-6]. There is no specific treatment of MeN, other than that for nonproteinuric CKD from any other cause.
This topic reviews MeN. The treatment of CKD is discussed elsewhere. (See "Overview of the management of chronic kidney disease in adults".)
The entity of MeN was first suggested when it was noted that a high percentage of patients initiated on dialysis in El Salvador had no obvious cause of chronic kidney disease (CKD) [7,8]. In a hospital study, among 205 patients initiated on dialysis between 1999 and 2000, the cause of end-stage renal disease (ESRD) was unknown in 135 patients .
A number of subsequently published studies revealed a high prevalence of CKD of unknown etiology in specific regions of El Salvador and Nicaragua, Guatemala, and Costa Rica [4,9]:
●In one study of 291 men from the coastlands of El Salvador, the prevalence of previously undiagnosed CKD (defined by creatinine ≥1.5 mg/dL) was 13 percent . Of these, only 38 percent had diabetes or hypertension (which are common causes of CKD in other areas), while the remainder did not appear to have a clear-cut cause for CKD. By contrast, the prevalence of CKD in the United States is approximately 5 percent . (See "Epidemiology of chronic kidney disease".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Brooks DR, Ramirez-Rubio O, Amador JJ. CKD in Central America: a hot issue. Am J Kidney Dis 2012; 59:481.
- 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.
- 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.
- 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.
- 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.
- Wegman D, Crowe J, Hogstedt C, et al. Mesoamerican nephropathy: Report from the second international research workshop on MeN. SALTRA/IRET-UNA, Heredia, Costa Rica, 2016. http://repositorio.una.ac.cr/bitstream/handle/11056/13142/MeN%202015%20Scientific%20Report%20high%20resolution_corregida.pdf? (Accessed on March 27, 2017).
- 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.
- 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.
- 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.
- 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.
- Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007; 298:2038.
- 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.
- Orantes CM, Herrera R, Almaguer M, et al. Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities. MEDICC Rev 2014; 16:23.
- 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.
- 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.
- Wesseling C, Aragón A, González M, et al. Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua. BMJ Open 2016; 6:e011034.
- 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.
- García-Trabanino R, Hernández C, Rosa A, et al. Incidence, mortality, and prevalence of end-stage chronic renal disease in the Bajo Lempa region of El Salvador: A ten-year community registry. Nefrologia 2016; 36:517.
- 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.
- Peraza S, Wesseling C, Aragon A, et al. Decreased kidney function among agricultural workers in El Salvador. Am J Kidney Dis 2012; 59:531.
- 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.
- Jayasumana C, Orantes C, Herrera R, et al. Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational and environmental determinants. Nephrol Dial Transplant 2017; 32:234.
- Elinder, C-G, Wernersson, A. and Wijkstrom, J. CINAC is not an appropriate name for the CKDu epidemic in Central America. Comment on Jayasumana C, Orantes C, Herrera R, et al. Chronic interstitial nephritis in agricultural communities: A worldwide epidemic with social, occupational and environmental determinants. Nephrol Dial Transplant 2016. http://academic.oup.com/ndt/article/32/2/234/2194445/Chronic-interstitial-nephritis-in-agricultural (Accessed on April 27, 2017).
- Johnson RJ. Pro: Heat stress as a potential etiology of Mesoamerican and Sri Lankan nephropathy: a late night consult with Sherlock Holmes. Nephrol Dial Transplant 2017; 32:598.
- 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.
- Athuraliya NT, Abeysekera TD, Amerasinghe PH, et al. Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka. Kidney Int 2011; 80:1212.
- Almaguer M, Herrera R, Orantes CM. Chronic kidney disease of unknown etiology in agricultural communities. MEDICC Rev 2014; 16:9.
- Wijetunge S, Ratnatunga NV, Abeysekera TD, et al. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages. Indian J Nephrol 2015; 25:274.
- Badurdeen Z, Nanayakkara N, Ratnatunga NV, et al. Chronic kidney disease of uncertain etiology in Sri Lanka is a possible sequel of interstitial nephritis! Clin Nephrol 2016; 86 (2016):106.
- 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.
- 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.
- Zoccali C. Causal mechanism and component causes in Mesoamerican-Sri Lankan nephropathy: the moderator's view. Nephrol Dial Transplant 2017; 32:607.
- Campese VM. Con: Mesoamerican nephropathy: is the problem dehydration or rehydration? Nephrol Dial Transplant 2017; 32:603.
- 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.
- Laws RL, Brooks DR, Amador JJ, et al. Changes in kidney function among Nicaraguan sugarcane workers. Int J Occup Environ Health 2015; 21:241.
- 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.
- 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.
- Wesseling C, van Wendel de Joode B, Ruepert C, et al. Paraquat in developing countries. Int J Occup Environ Health 2001; 7:275.
- 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.
- Crowe J, Wesseling C, Solano BR, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med 2013; 56:1157.
- Fischer RSB, Mandayam S, Chavarria D, et al. Clinical Evidence of Acute Mesoamerican Nephropathy. Am J Trop Med Hyg 2017; 97:1247.
- Fischer RSB, Vangala C, Truong L, et al. Early detection of acute tubulointerstitial nephritis in the genesis of Mesoamerican nephropathy. Kidney Int 2017.
- Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int 2015; 87:792.
- Bedford M, Farmer C, Levin A, et al. Acute kidney injury and CKD: chicken or egg? Am J Kidney Dis 2012; 59:485.
- Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012; 82:516.
- 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.
- Robey RB. Cyclical dehydration-induced renal injury and Mesoamerican nephropathy: as sweet by any other name? Kidney Int 2014; 86:226.
- Roncal Jimenez CA, Ishimoto T, Lanaspa MA, et al. Fructokinase activity mediates dehydration-induced renal injury. Kidney Int 2014; 86:294.
- Roncal-Jimenez C, García-Trabanino R, Barregard L, et al. Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy. Am J Kidney Dis 2016; 67:20.
- 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.
- Crowe J, Nilsson M, Kjellstrom T, Wesseling C. Heat-related symptoms in sugarcane harvesters. Am J Ind Med 2015; 58:541.
- 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.
- 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
- Wijkström J, González-Quiroz M, Hernandez M, et al. Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican Nephropathy. Am J Kidney Dis 2017; 69:626.
- Kupferman J, Amador JJ, Lynch KE, et al. Characterization of Mesoamerican Nephropathy in a Kidney Failure Hotspot in Nicaragua. Am J Kidney Dis 2016; 68:716.
- 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.
- Wernerson A, Wijkström J, Elinder CG. Update on endemic nephropathies. Curr Opin Nephrol Hypertens 2014; 23:232.
- 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.
- Bodin T, García-Trabanino R, Weiss I, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med 2016; 73:409.
- Wegman DH, Apelqvist J, Bottai M, et al. Intervention to diminish dehydration and kidney damage among sugarcane workers. Scand J Work Environ Health 2017.
- 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.