Part 1- Introduction
History of the Epidemic in Central America
Statistics
Chronic Kidney Disease – basics
Part 2 – Research and
Literature Review
Introduction to the Research
Etiology
Morphology and Pathology
Possible Solutions
Areas for Additional Research
Part 3 – Social Impacts
Narrative
Financial
Impacts
Part 4 - Interventions
Research Introduction
There have been numerous
studies regarding the etiology, diagnosis, and epidemiological trends surrounding
Mesoamerican nephropathy (MeN), however, there is much that remains unknown
about MeN as a form of chronic kidney disease. With an estimated twenty
thousand deaths since 2002, it is crucial that research is conducted to fully
understand what causes MeN. Not only is this a major public health concern
because this form of kidney disease is associated with significant morbidity
and high mortality rates in affected areas, but dialysis and transplants as
methods of replacing renal function is not widely offered or available in many
areas where Mesoamerican nephropathy is endemic (Correa-Rotter, Wesseling,
& Johnson, 2014).
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Etiology
In the academic article,
“CKD of Unknown Origin
in Central America: The Case for a Mesoamerican Nephropathy”, several
possible causes for this disease are summarized. Authors include possible
chemical or pesticide exposure, infectious diseases including leptospirosis,
repeated heat stress and associated dehydration, childhood exposures, and
illegal alcohol use. Social determinants of health, including low socioeconomic
status, are also addressed as it is believed it may push people to work long
hours in very difficult physical conditions to achieve economic stability
(Correa-Rotter, Wesseling, & Johnson, 2014).
Many
of these causes were addressed at the First International Research Workshop on
Mesoamerican Nephropathy that took place in Costa Rica in 2012 (Wesseling, et
al, Program on Work, Environment and Health in Central America, & Central
American Institute for Studies on Toxic Substances). Research on MeN has
increased and evolved over the last several years. For instance, at the Second
International Research Workshop on Mesoamerican Nephropathy, held in 2015, it
was emphasized that deleterious health effects of repeated dehydration and heat
stress may be more strongly linked to chronic kidney disease of unknown origin
than previously thought, while other possible theories, such as heavy metals
and pesticide use, have become less widely accepted (Wesseling, et al, Program
on Work, Environment and Health in Central America, & Central American
Institute for Studies on Toxic Substances, 2015). Additional research has led
to an even stronger association between MeN and occupational health, while
diseases of similar pathology have been identified in other areas of the world.
Due to the wide variety of possible causal factors, it seems unlikely that there
is only one true cause of Mesoamerican nephropathy.
Morphology and Pathology
A study published in the
American Journal of Kidney Disease,
assessed the morphologic findings of Mesoamerican kidney disease. Although a
small study of eight men with clinical diagnosis of Mesoamerican nephropathy
and a history of agricultural work, all participants had similar findings on
kidney biopsies. Their idney biopsies demonstrated chronic glomerular and
tubulointerstitial damage (Wiljkstrom, et al, 2013). Other tests that aid
in diagnosis that have been used in this study, as well as other studies
addressing pathology include blood tests that look at estimated glomerular
filtration rate and low potassium, as well as urine tests that look for protein
in the urine (Wiljkstrom, Leiva, et al, 2013).
Another study that highlights
the biological changes that occurs in MeN, was a longitudinal study conducted
amongst twenty-nine male sugarcane workers from the Leon and Chinandega areas
of Nicaragua; both are areas that are heavily affected by MeN. All participants
included in the study did not have preexisting kidney disease or diabetes.
(Note: Diabetes is a known factor in many cases of kidney disease.)
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| Some of the defining characteristics that distinguish more traditional chronic kidney disease from chronic kidney disease of unknown origin, also referred to as MeN https://laislafoundation.org/wp-content/uploads/2012/08/CKDu.jpg?7a2409 |
The participants had
urine and blood taken before and after their work shift on the first day, sixth
day, and after 9 weeks. The blood and urine results were shown to have
increases in creatinine and blood urea nitrogen with a decrease in glomerular
filtration rate - all of which are associated with renal disease - when compared
with a reference group. Furthermore, changes were even noted across the
workers’ shifts. The authors suggest repeated heat stress and possible use of
non-steroidal anti-inflammatory drugs (NSAIDS), which can strain the kidneys as
possible causes of MeN (Wesseling, Aragon, Gonzalez, Weiss, Glaser, Bobadilla,
Roncal-Jimenez, Correa-Rotter, Johnson, & Barregard, 2016).
Possible Solutions
Given a likely
multifactorial cause, there are a variety of suggestions throughout research to
prevent development of MeN. For those working in the heat, protection from the
sun and rest periods are recommended, as well as adequate hydration. It is also
recommended to avoid the use of NSAID medications to prevent additional strain
to the kidneys. Controlling pesticide use is also recommended to minimize the
plethora of health risks that often accompany its use (Elinder, Wernerson,
& Wijkstrom, 2015). Due to the likely involvement of numerous social
determinants of health, it is important to also consider public health
interventions that may alleviate poverty and health disparities in affected
countries.
Areas for Additional Research
Additional research
regarding the etiology of Mesoamerican nephropathy is necessary for specific
public health prevention and treatment programs to be implemented.
Further detailing and examining the role of social determinants of health
may also provide additional insight and can help frame public health
interventions (Wesseling, Crowe, Hogstedt, Jakobsson, Lucas, Wegman, Program on
Work, Environment and Health in Central America, & Central American
Institute for Studies on Toxic Substances, 2012). It is critical that more
research be conducted on the morphology of MeN so that a diagnosis can be
confirmed by objective means. This will provide researchers and clinicians a
clearer understanding of the disease, and will ideally help to decrease the
associated morbidity and mortality. As a step in that direction, at the First
International Research Workshop on Mesoamerican Nephropathy, it was suggested
that more resources be allocated to active surveillance of the disease. More
resources will open the door for obtaining more data regarding incidence,
mortality, and natural history of the disease, as well as focus efforts on
improving active surveillance of the disease (Wesseling, Crowe, Hogstedt,
Jakobsson, Lucas, Wegman, Program on Work, Environment and Health in Central
America, & Central American Institute for Studies on Toxic Substances,
2012).
Continue to Part 3 - Social Impacts
References
Brooks,
D., Ramirez-Rubio, O., & Amador, J. (2012, April). CKD in Central America:
A
Hot Issue. American Journal of Kidney
Diseases, 59(4), 481-484.
http://dx.doi.org/10.1053/j.ajkd.2012.01.005
Correa-Rotter,
R., Wesseling, C., & Johnson, R. (2014, March). CKD of Unknown
Origin in Central America: The Case for a
Mesoamerican Nephropathy.
American Journal of Kidney Diseases,
63(3), 506-520.
http://dx.doi.proxy.cc.uic.edu/10.1053/j.ajkd.2013.10.062
Elinder,
G., Wernerson, A, & Wijkstrom, J. (2015, August 25). Mesoamerican
Nephropathy (MeN): A “New” Chronic
Kidney Disease related to Occupational Heat Exposure with
Repeated Deprivation of Salts and Water.
International Journal of Nephrology and Kidney Failure, 1(2).
http://dx.doi.org/10.16966/2380-5498.109
Wesseling,
C, Aragon, A., Gonzalez, M., Weiss, I., Glaser, J., Bobadilla, N., Roncal-
Jimenez, C., Correa-Rotter, R., Johnson,
R., Barregard, L. (2016, May). Kidney
function in sugarcane cutters in
Nicaragua- A longitudinal study of workers
at risk of Mesoamerican nephropathy. Environmental
Research 147, 125-132.
http://dx.doi.org/10.1016/j.envres.2016.02.002
Wesseling,
C., Crowe, J., Hogstedt, C., Jakobsson, K., Lucas, R., & Wegman, D. (2012).
Mesoamerican Nephropathy: Report from the
International Research
Workship on MeN. Retrieved from
http://www.regionalnephropathy.org/wpcontent/uploads/2013/04/Techni
cal-Report-for-Website-Final.pdf
Wesseling, C., Crowe, J., Hogstedt, C.,
Jakobsson, K., Wegman, D, Program on Work,
Environment and Health in
Central America, & Central American Institute for
Studies on Toxic
Substances. (2015). Mesoamerican Nephropathy: Report
from the Second International Research Workshop on MeN.
Retrieved from http://www.regionalnephropathy.org/wp-content/uploads/2016/08/MeN-
2015-Scientific-Report-high-resolution_final.pdf
Wijkstrom,
J., Leiva, R., Elinder, C., Leiva, S., Trujillo, Z., Trujillo, L., Soderberg,
M.,
Hultenby, K., & Wernerson, A. (2013,
November). Clinical and Pathological
Characterization of Mesoamerican
Nephropathy: A New Kidney Disease in
Central America. American Journal of
Kidney Disease, 62(5), 908-918.
http://dx.doi.org.proxy/uic.edu/10.1053/j.ajkd.2013.05.019
World
Health Organization. (2008). Disease and Injury Country Estimates. Retrieved
October 24, 2016, from
http://www.who.int/healthinfo/golbal_burden_disease/estimates_country/
en/
World
Health Organization. (Last Updated 2015, January). El Salvador: WHO
Statistical Profile. Retrieved from
http://www.who.int/gho/countries/slv.pdf?ua=1.
World
Health Organization. (Last Updated 2015, January). Nicaragua: WHO
Statistical Profile. Retrieved from
http://www.who.int/gho/countries/nic.pdf?ua=1
This
series was researched and written by (in alphabetical order): Jessica Chepp,
Aleena McDaniel, Cara McShane, Christine Spees, and Kimberly Vargas
All are Master of Public Health candidates at the University of Illinois - Chicago
All are Master of Public Health candidates at the University of Illinois - Chicago
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