CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy

Abstract

An epidemic of chronic kidney disease of unknown origin has emerged in the last decade in Central America and has been named Mesoamerican nephropathy. This form of chronic kidney disease is present primarily in young male agricultural workers from communities along the Pacific coast, especially workers in the sugarcane fields. In general, these men have a history of manual labor under very hot conditions in agricultural fields. Clinically, they usually present with normal or mildly elevated systemic blood pressure, asymptomatic yet progressive reduction in estimated glomerular filtration rate, low-grade non-nephrotic proteinuria, and often hyperuricemia and or hypokalemia. Diabetes is absent in this population. Kidney biopsies that have been performed show a chronic tubulointerstitial disease with associated secondary glomerulosclerosis and some signs of glomerular ischemia. The cause of the disease is unknown; this article discusses and analyzes some of the etiologic possibilities currently under consideration. It is relevant to highlight that recurrent dehydration is suggested in multiple studies, a condition that possibly could be exacerbated in some cases by other conditions, including the use of nonsteroidal anti-inflammatory agents. At present, Mesoamerican nephropathy is a medical enigma yet to be solved.

Keywords: Chronic kidney disease; Mesoamerica.

Figure 1

Geographic region known as Mesoamerica incudes Southeastern Mexico, Guatemala, Belize, El Salvador, Honduras, Nicaragua, Costa Rica, and Panama.

Figure 2

Possible causes for Mesoamerican nephropathy. Abbreviations: CKD, chronic kidney disease; NSAIDs, nonsteroidal anti-inflammatory drugs.