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Am J Kidney Dis. 2017 May;69(5):626-636. doi: 10.1053/j.ajkd.2016.10.036. Epub 2017 Jan 23.

Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican Nephropathy.

Author information

1
Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
2
Research Center on Health, Work and Environment, National Autonomous University of Nicaragua at León, León, Nicaragua; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
3
Department of Pediatrics, National Autonomous University of Nicaragua at León, León, Nicaragua.
4
Servicio de Nefrología, Hospital Nacional Rosales, San Salvador, El Salvador.
5
Division of CRC, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
6
Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
7
Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden; Drug Safety and Metabolism, AstraZeneca, Mölndal, Stockholm, Sweden.
8
Research Center on Health, Work and Environment, National Autonomous University of Nicaragua at León, León, Nicaragua.
9
Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: annika.wernerson@ki.se.

Abstract

BACKGROUND:

Mesoamerican nephropathy (MeN) is a chronic kidney disease affecting rural inhabitants in Central America. We have previously described the renal morphology in 8 patients from El Salvador. To confirm the renal pathology, we have studied kidney biopsies from patients with MeN in Nicaragua. Follow-up urine and blood samples from both biopsy studies were collected to investigate the natural history.

STUDY DESIGN:

Case series.

SETTINGS & PARTICIPANTS:

In the kidney biopsy study, 19 male sugarcane workers in Nicaragua with suspected MeN were investigated with questionnaires, kidney biopsies, and blood and urine analysis. Inclusion criteria were age 20 to 65 years and plasma creatinine level of 1.13 to 2.49mg/dL or estimated glomerular filtration rate (eGFR) of 30 to 80mL/min/1.73m2. Exclusion criteria were proteinuria with protein excretion > 3g/24 h, uncontrolled hypertension, diabetes mellitus, or other known kidney disease. In the follow up-study, blood and urine from the kidney biopsy study in Nicaragua (n=18) and our previous biopsy study of MeN cases in El Salvador (n=7) were collected 1 to 1.5 and 2 to 2.5 years after biopsy, respectively.

OUTCOMES:

Renal morphology, clinical, and biochemical characteristics, change in eGFR per year.

MEASUREMENTS:

eGFR was calculated using the CKD-EPI creatinine (eGFRcr), cystatin C (eGFRcys), and creatinine-cystatin C (eGFRcr-cys) equations.

RESULTS:

In the kidney biopsy study, participants had a mean eGFRcr of 57 (range, 33-96) mL/min/1.73m2. 47% had low plasma sodium and 21% had low plasma potassium levels. 16 kidney biopsies were representative and showed glomerulosclerosis (mean, 38%), glomerular hypertrophy, and signs of chronic glomerular ischemia. Mild to moderate tubulointerstitial damage and mostly mild vascular changes were seen. In the follow up-study, median duration of follow-up was 13 (range, 13-27) months. Mean change in eGFRcr was -4.4±8.4 (range, -27.7 to 10.2) mL/min/1.73m2 per year. Most patients had stopped working with sugarcane cultivation.

LIMITATIONS:

3 biopsy specimens had 4 or fewer glomeruli.

CONCLUSIONS:

This study confirms the renal morphology of MeN: chronic glomerular and tubulointerstitial damage with glomerulosclerosis and chronic glomerular ischemia. Follow-up data show that eGFRs, on average, deteriorated.

KEYWORDS:

CKD of unknown etiology (CKDu); Central America; El Salvador; Mesoamerican nephropathy (MeN); Nicaragua; chronic kidney disease (CKD); dehydration; disease progression; endemic nephropathy; environmental exposure; heat stress; kidney biopsy; renal morphology; renal pathology; sugarcane

PMID:
28126239
DOI:
10.1053/j.ajkd.2016.10.036
[Indexed for MEDLINE]
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