1921
Volume 97, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Mesoamerican nephropathy (MeN), an epidemic of unexplained kidney disease in Central America, affects mostly young, healthy individuals. Its etiology is a mystery that requires urgent investigation. Largely described as a chronic kidney disease (CKD), no acute clinical scenario has been characterized. An understanding of the early disease process could elucidate an etiology and guide treatment and prevention efforts. We sought to document the earliest clinical signs in patients with suspected MeN in a high-risk population in Nicaragua. Physicians at a local hospital identified suspect cases and documented clinical/laboratory data, demographics, and medical histories. Over a 1-year period, physicians identified 255 mostly young (median 29 years), male (89.5%) patients with elevated creatinine or reduced creatinine clearance. Mean serum creatinine (2.0 ± 0.6 mg/dL) revealed a 2-fold increase from baseline, and half had stage 2 or 3 acute kidney injury. Leukocyturia (98.4%), leukocytosis (81.4%), and neutrophilia (86.2%) predominated. Nausea (59.4%), back pain (57.9%), fever (54.6%), vomiting (50.4%), headache (47.3%), and muscle weakness (45.0%) were common. A typical case of acute MeN presented with elevated (or increased ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline) creatinine, no hypertension or diabetes, leukocyturia, and at least two of fever, nausea or vomiting, back pain, muscle weakness, headache, or leukocytosis and/or neutrophilia. Rapid progression (median 90 days) to CKD was recorded in 8.5% of patients. This evidence can serve as the basis of a sensitive and urgently needed case definition for disease surveillance of early-stage, acute MeN.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.17-0260
2017-10-11
2018-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/4/tpmd170260.html?itemId=/content/journals/10.4269/ajtmh.17-0260&mimeType=html&fmt=ahah

References

  1. Ramirez-Rubio O, McClean MD, Amador JJ, Brooks DR, , 2012. An epidemic of chronic kidney disease in Central America: an overview. J Epidemiol Community Health 67: 13.[Crossref]
  2. Trabanino RG, Aguilar R, Silva CR, Mercado MO, Merino RL, , 2002. End-stage renal disease among patients in a referral hospital in El Salvador. Rev Panam Salud Publica 12: 202206.[Crossref]
  3. Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH, , eds., 2013. First International Research Workshop on Mesoamerican Nephropathy (MeN). Available at: http://www.repositorio.una.ac.cr/bitstream/handle/11056/8584/seriesaludytrabajo10.pdf?sequence=1&isAllowed=y. Accessed.
  4. Wesseling C, van Wendel de Joode B, Crowe J, Rittner R, Sanati NA, Hogstedt C, Jakobsson K, , 2015. Mesoamerican nephropathy: geographical distribution and time trends of chronic kidney disease mortality between 1970 and 2012 in Costa Rica. Occup Environ Med 72: 714721.[Crossref]
  5. Torres C, Aragón A, González M, López I, Jakobsson K, Elinder C-GG, Lundberg I, Wesseling C, , 2010. Decreased kidney function of unknown cause in Nicaragua: a community-based survey. Am J Kidney Dis 55: 485496.[Crossref]
  6. Murray KO, Fischer RSB, Chavarria D, Duttmann C, Garcia MN, Gorchakov R, Hotez PJ, Jiron W, Leibler JH, Lopez JE, Mandayam S, Marin A, Sheleby J, , 2015. Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology? Microbes Infect 17: 671675.[Crossref]
  7. Ramirez-Rubio O, Brooks DR, Amador JJ, Kaufman JS, Weiner DE, Scammell MK, , 2011. Summary Report: Chronic Kidney Disease in Nicaragua: A Qualitative Analysis of Semi-Structured Interviews with Physicians and Pharmacists. Available at: www.cao-ombudsman.org/cases/document-links/documents/BU_Interviews_Report_FEB_2012_Eng.pdf. Accessed August 2, 2017.
  8. Orantes CM, Herrera R, Almaguer M, Brizuela EG, Núñez L, Alvarado NP, Fuentes de Morales EJ, Bayarre HD, Amaya JC, Calero DJ, Vela XF, Zelaya SM, Granados DV, de Figueroa PO, , 2014. Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities. MEDICC Rev 16: 2330.
  9. Sanoff SL, Callejas L, Alonso CD, Hu Y, Colindres RE, Chin H, Morgan DR, Hogan SL, , 2010. Positive association of renal insufficiency with agriculture employment and unregulated alcohol consumption in Nicaragua. Ren Fail 32: 766777.[Crossref]
  10. Pan American Health Organization, 2013. Chronic Kidney Disease in Agricultural Communities in Central America. Washington, DC. Available at: http://iris.paho.org/xmlui/handle/123456789/4786. Accessed January 15, 2017.
  11. Orantes CM, Herrera R, Almaguer M, Brizuela EG, Hernández CE, Bayarre H, Amaya JC, Calero DJ, Orellana P, Colindres RM, Velázquez ME, Núñez SG, Contreras VM, Castro BE, , 2011. Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009. MEDICC Rev 13: 1422.
  12. Weiner DE, McClean MD, Kaufman JS, Brooks DR, , 2013. The Central American epidemic of CKD. Clin J Am Soc Nephrol 8: 504511.[Crossref]
  13. Cockcroft DW, Gault MH, , 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16: 3141.[Crossref]
  14. Myers GL, Miller WG, Coresh J, Fleming J, Greenberg N, Greene T, Hostetter T, Levey AS, Panteghini M, Welch M, Eckfeldt JH, , 2006. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 52: 518.[Crossref]
  15. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D, , 1999. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130: 461470.[Crossref]
  16. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F, , 2006. Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145: 247254.[Crossref]
  17. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, , 2009. A new equation to estimate glomerular filtration rate. Ann Intern Med 150: 604612.[Crossref]
  18. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, , and the Acute Kidney Injury Network, 2007. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11: R31.[Crossref]
  19. National Kidney Foundation, 2002. KDOQI Clinical Practice Guidelines for chronic kidney disease: part 4. Definition and classification of stages of chronic kidney disease. Am J Kidney Dis 39: S46S75.[Crossref]
  20. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group, 2013. KDIGO 2012 Clinical Practice Guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3: 1150.[Crossref]
  21. Lopez-Marin L, Chavez Y, Garcia X, Flores W, Garcia Y, Herrera R, Almaguer M, Orantes CM, Calero DJ, Bayarre HD, Amaya JC, Magaña S, Espinoza PA, Serpas L, , 2014. Histopathology of chronic kidney disease of unknown etiology in Salvadoran agricultural communities. MEDICC Rev 16: 4954.
  22. Wijkström J, Leiva R, Elinder CG, Leiva S, Trujillo Z, Trujillo L, Söderberg M, Hultenby K, Wernerson A, , 2013. Clinical and pathological characterization of Mesoamerican nephropathy: a new kidney disease in Central America. Am J Kidney Dis 62: 908918.[Crossref]
  23. Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW, , 2005. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16: 33653370.[Crossref]
  24. Fujii T, Uchino S, Takinami M, Bellomo R, , 2014. Validation of the kidney disease improving global outcomes criteria for AKI and comparison of three criteria in hospitalized patients. Clin J Am Soc Nephrol 9: 848854.[Crossref]
  25. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL, , 2013. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol 8: 14821493.[Crossref]
  26. Coca SG, Yusuf B, Shlipak MG, Garg AX, Parikh CR, , 2009. Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53: 961973.[Crossref]
  27. Macedo E, Bouchard J, Mehta RL, , 2008. Renal recovery following acute kidney injury. Curr Opin Crit Care 14: 660665.[Crossref]
  28. González E, Gutiérrez E, Galeano C, Chevia C, de Sequera P, Bernis C, Parra EG, Delgado R, Sanz M, Ortiz M, Goicoechea M, Quereda C, Olea T, Bouarich H, Hernández Y, Segovia B, Praga M, , 2008. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 73: 940946.[Crossref]
  29. U.S. Centers for Disease Control and Prevention, 2007. Prevalence of chronic kidney disease and associated risk factors—United States, 1999–2004. MMWR Morb Mortal Wkly Rep 56: 161165.
  30. Weiss G, Goodnough LT, , 2012. Anemia of chronic disease. N Engl J Med 352: 10111023.[Crossref]
  31. Herrera R, Orantes C, Almaguer M, Alfonso P, Bayarre HD, Leiva IM, Smith MJ, Cubías RA, Torres CG, Almendárez WO, Cubías FR, Morales FE, Magaña S, Amaya JC, Perdomo E, Ventura MC, Villatoro JF, Vela XF, Zelaya SM, Granados DV, Vela E, Orellana P, Hevia R, Fuentes J, Mañalich R, Bacallao R, Ugarte M, Arias MI, Chávez J, Flores NE, Aparicio CE, , 2014. Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities. MEDICC Rev 16: 3948.
  32. Kupferman J, Amador JJ, Lynch KE, Laws RL, López-Pilarte D, Ramírez-Rubio O, Kaufman JS, Lau JL, Weiner DE, Robles NV, Verma KP, Scammell MK, McClean MD, Brooks DR, Friedman DJ, , 2016. Characterization of Mesoamerican nephropathy in a kidney failure hotspot in Nicaragua. Am J Kidney Dis 68: 716725.[Crossref]
  33. Lunyera J, Mohottige D, Von Isenburg M, Jeuland M, Patel UD, Stanifer JW, von Isenburg M, Jeuland M, Patel UD, Stanifer JW, Von Isenburg M, Jeuland M, Patel UD, Stanifer JW, , 2016. CKD of uncertain etiology: a systematic review. Clin J Am Soc Nephrol 11: 379385.[Crossref]
  34. Roncal-Jimenez C, García-Trabanino R, Barregard L, Lanaspa MA, Wesseling C, Harra T, Aragón A, Grases F, Jarquin ER, González MA, Weiss I, Glaser J, Sánchez-Lozada LG, Johnson RJ, Aragón A, Grases F, Jarquin ER, González MA, Weiss I, Glaser J, Sánchez-Lozada LG, Johnson RJ, , 2015. Heat stress nephropathy from exercise-induced uric acid crystalluria: a perspective on Mesoamerican nephropathy. Am J Kidney Dis 67: 2030.[Crossref]
  35. Garcia-Trabanino R, Jarquin E, Wesseling C, Johnson RJ, Gonzalez-Quiroz M, Weiss I, Glaser J, Jose Vindell J, Stockfelt L, Roncal C, Harra T, Barregard L, , 2015. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador: a cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res 142: 746755.[Crossref]
  36. Levey AS, Stevens LA, , 2010. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 55: 622627.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0260
Loading
/content/journals/10.4269/ajtmh.17-0260
Loading

Data & Media loading...

  • Received : 30 Mar 2017
  • Accepted : 09 May 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error