Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology?

Murray, Kristy O.; Fischer, R.; Chavarria, Denis; Düttmann, Christiane; Garcia, Melissa N.; Gorchakov, Rodion; Hotez, Peter J.; Jirón, William; Leibler, Jessica H.; López, Job E.; Mandayam, Sreedhar; Marín, Alejandro Ferreiro; Sheleby, Jessica

doi:10.1016/j.micinf.2015.08.005

Cited by 42 publications

(31 citation statements)

References 25 publications

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“…It was suggested that small farmers have more control over their working conditions than laborers (31). Non-agricultural occupations with reported moderate-high prevalence of kidney dysfunction are construction workers 5-15%, miners 6-16%; port workers with heavy labor (8%), fishermen 7%, and shrimp farm workers 10% (17,28,30,32). A recent case-control study in a Nicaraguan mining area found an >4-fold risk for low kidney function among those who had ever worked in mining or construction (33).…”

Section: Prevalence Studies Suggest Occupational Etiologymentioning

confidence: 99%

“…All could have an occupational component, all could potentially exacerbate effects of heat stress, and all could affect disease progression, but few data exist so far. Based on observations of acute nephropathy in sugarcane workers and infestation of rodents in sugarcane fields in Nicaragua, leptospirosis or Hantavirus were hypothesized initially (32). Leptospira seropositivity was highest among sugarcane cutters as compared to other job categories in cane production and seropositive workers had higher NGAL levels, but there were no associations with kidney dysfunction that could explain the CKDnt epidemic (68).…”

Section: Infectious Agentsmentioning

confidence: 99%

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Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Wesseling

Glaser²,

Rodríguez-Guzmán

et al. 2020

Revista Panamericana De Salud Pública

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The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.

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Section: Prevalence Studies Suggest Occupational Etiologymentioning

confidence: 99%

Section: Infectious Agentsmentioning

confidence: 99%

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Wesseling

Glaser²,

Rodríguez-Guzmán

et al. 2020

Revista Panamericana De Salud Pública

View full text Add to dashboard Cite

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“…Another example is the sugarcane fields in Chichigalpa, Chinandega in Nicaragua, a focus of CKDu development, where leptospirosis is prevalent, with a major outbreak occurring in 1995 after flooding [16,17]. In these CKDu patients, some have experienced clinical manifestations of acute infection, similar to having episodes of acute leptospirosis [18]. Thus, it is speculated that infectious pathogens particularly leptospira, shedding through urine and feces from highly infested rodents, may infect workers during the process of cultivating and harvesting sugarcane or after exposure to major flooding containing leptospira [18].…”

Section: Ckd Hotspots Versus Leptospirosis Global Mapmentioning

confidence: 99%

“…In these CKDu patients, some have experienced clinical manifestations of acute infection, similar to having episodes of acute leptospirosis [18]. Thus, it is speculated that infectious pathogens particularly leptospira, shedding through urine and feces from highly infested rodents, may infect workers during the process of cultivating and harvesting sugarcane or after exposure to major flooding containing leptospira [18]. Once infected, this difficult-to-diagnose neglected tropical disease, particularly in the resourcepoor setting, may hinder proper clinical identification and timely treatment.…”

Section: Ckd Hotspots Versus Leptospirosis Global Mapmentioning

confidence: 99%

Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology

Yang¹

2017

Nephron

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Leptospirosis is the most prevalent zoonosis affecting more than 1 million populations worldwide. Interestingly, leptospirosis endemic regions coincide with chronic kidney disease (CKD) hotspots largely due to flooding and agricultural overlaps. Acute leptospirosis induces multiple organ dysfunction including acute kidney injury and may predispose to CKD and end-stage renal disease, if not treated timely. Asymptomatic infection may carry the bacteria in the kidney and CKD progresses insidiously. Histologic finding of leptospirosis renal disease includes tubulointerstitial nephritis, interstitial fibrosis, and tubular atrophy. Proximal tubule dysfunction and hypokalemia are observed in adult male workers with leptospirosis, a characteristic similarity to CKD unknown etiology (CKDu). CKDu is a form of CKD that is not attributable to traditional risk factors clustering in agricultural communities affecting young male farmers. Kidney pathology shows a chronic tubulointerstitial disease. CKDu is being reported as an endemic nephropathy across the globe. Recent surveys suggest that asymptomatic leptospira renal colonization is an overlooked risk for renal fibrosis and CKDu. Population with anti-leptospira seropositivity is associated with lower estimated glomerular filtration rate in endemic regions and carrier may progress to CKD. Leptospirosis has been considered as a risk factor for CKDu in Sri Lanka and in Mesoamerican area. Sugarcane workers in Nicaragua showed increased anti-leptospira seropositivity and higher urinary biomarkers for kidney injury. Emerging evidence with signs of infection were reported in these endemic population, indicating that leptospira exposure could play a role in CKDu as a cause of primary kidney disease or a susceptible factor when secondary injury such as heat stress or dehydration aggravates kidney disease. Therefore, leptospirosis as an emerging culprit of CKDu deserves further in-depth investigation.

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“…Two major syndromes can develop from the 100,000 new cases of hantavirus exposure each year both of which may have associated renal involvement: hanta pulmonary syndrome and hemorrhagic fever with renal syndrome. Hantavirus has recently been implicated as one potential explanation for mesoamerican nephropathy (30).…”

Section: Acute and Subacute Viral-induced Gnmentioning

confidence: 99%

Viral-Associated GN: Hepatitis B and Other Viral Infections

Kupin

2016

CJASN

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By definition, viral-associated GN indicates the direct pathogenic relationship between active viral replication and the development of acute GN. This definition is in sharp contrast to the semantic label and pathophysiologic foundation behind postinfectious GN that uniquely develops only during a period of resolved and absent active infection. The primary example of postinfectious GN are the glomerular lesions described after a pharyngeal or cutaneous streptococcal infection and do not represent the clinical or immunologic pattern seen with viralassociated GN. Hepatitis B (HBV) is the most common chronic viral infection in the world affecting >400 million people which is more than double the prevalence of chronic HIV and hepatitis C carriers combined. In addition, 10%-20% of HBV patients may be coinfected with hepatitis C and 5%-10% will have coinfection with HIV. Being able to distinguish the different types of GN seen with each viral infection is essential for the practicing clinician as each virus requires its own specific antiviral therapy. HBV-induced immune complex disease with renal injury lies on one end of the spectrum of disorders that occurs after a prolonged chronic carrier state. On the opposite end of the spectrum are renal diseases that develop from acute or subacute viral infections. One important glomerular lesion in this category is the association of collapsing FSGS with acute active cytomegalovirus, Epstein-Barr virus, and parvovirus B19 infection. The data supporting or disproving this relationship for each of these viruses will be discussed. A second renal manifestation of acute viral infections often occurs with many different sporadic or epidemic infections such as dengue and hantavirus and can lead to a transient proliferative GN that resolves upon viral clearance. The complex interplay of HBV and all viruses with the immune system provides conceptual lessons on the pathophysiology of immune complex GN that can be applied to all infection-related renal disease and plays an integral role in developing an approach to therapeutic intervention.

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Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology?

Cited by 42 publications

References 25 publications

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Leptospirosis Renal Disease: Emerging Culprit of Chronic Kidney Disease Unknown Etiology

Viral-Associated GN: Hepatitis B and Other Viral Infections

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