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Milki AA, Bechara M, Lew SQ, Poon AN. Chronic Kidney Disease of Non-traditional Etiology in a Young Man From Central America: Geography, Poverty, and Uncertain Pathophysiology Create a Formidable Medical Challenge. Cureus 2023; 15:e38876. [PMID: 37303355 PMCID: PMC10257359 DOI: 10.7759/cureus.38876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
A man in his early 20s with kidney biopsy-confirmed focal segmental glomerulosclerosis (FSGS) was admitted with one month of nausea and vomiting, intermittent episodes of confusion, shortness of breath, and dysuria. He reported that many people from his native village in Central America, where he harvested sugarcane as a child, have died from kidney disease, including his father and cousin. He believed the source of disease to be agrochemicals found in the village's water supply. Although FSGS would be a rare manifestation, the patient's risk factors strongly suggested chronic kidney disease of unknown etiology (CKDu) - also known as Mesoamerican nephropathy (MeN) - a phenomenon he had never previously heard of. He took lisinopril for the last six years to manage his kidney disease. Due to uremic symptoms and abnormal electrolytes, he was initiated on hemodialysis.
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Affiliation(s)
- Anthony A Milki
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Michael Bechara
- Department of Medicine, Division of Hospital Medicine, Virginia Hospital Center, Arlington, USA
| | - Susie Q Lew
- Department of Medicine, Division of Kidney Disease and Hypertension, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Adrienne N Poon
- Department of Medicine, Division of Hospital Medicine, George Washington University School of Medicine and Health Sciences, Washington, USA
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Rojas-Garbanzo M, Whitehead L, Zhang K, Delclos GL. Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1308. [PMID: 36674063 PMCID: PMC9859154 DOI: 10.3390/ijerph20021308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. METHODS We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. RESULTS The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30-49 years: OR = 2.38, 95% CI 1.03-5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14-25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18-5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. CONCLUSION Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.
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Affiliation(s)
- Erika Figueroa-Solis
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX 78229, USA
| | - Marianela Rojas-Garbanzo
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), National University of Costa Rica, Heredia 40101, Costa Rica
| | - Lawrence Whitehead
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
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Chapman CL, Hess HW, Lucas RAI, Glaser J, Saran R, Bragg-Gresham J, Wegman DH, Hansson E, Minson CT, Schlader ZJ. Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States. Am J Physiol Regul Integr Comp Physiol 2021; 321:R141-R151. [PMID: 34161738 DOI: 10.1152/ajpregu.00103.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
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Affiliation(s)
| | - Hayden W Hess
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jason Glaser
- La Isla Network, Washington, D.C.,Responsible Business Center at Birkbeck, University of London, London, United Kingdom
| | - Rajiv Saran
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Wegman
- Department of Epidemiology, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Erik Hansson
- La Isla Network, Washington, D.C.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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Smith DJ, Pius LM, Plantinga LC, Thompson LM, Mac V, Hertzberg VS. Heat Stress and Kidney Function in Farmworkers in the US: A Scoping Review. J Agromedicine 2021; 27:183-192. [PMID: 33691597 DOI: 10.1080/1059924x.2021.1893883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic kidney disease of unknown etiology (CKDu) has been well described in farmworkers in Latin America. Agricultural workers in the United States (US) are exposed to similar hot and humid working conditions, but CKDu in the US is under-described. This review aims to better understand the current literature describing the connection between heat stress and kidney function in farmworkers in the United States. Utilizing a scoping review methodology, we searched CINAHL, Embase, PubMed, and Web of Science databases to better understand the current state of the heat stress and kidney function research in farmworkers within the United States. In this review, 229 pieces of literature were screened. Ultimately, 4 articles were chosen to be included in the scoping review. Common themes within the articles were variations in study protocol lengths and type of heat stress measurement. Additionally, the majority of the work completed was quantitative to date, with only one study providing a critical social lens for analysis of CKDu in the United States. We found evidence that more work is needed within the US to understand the relationship between working in the heat and kidney function in agricultural and other workers who experience high heat conditions at work and are susceptible to the deleterious effects of working in said conditions.
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Affiliation(s)
- Daniel J Smith
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Lisa M Pius
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Laura C Plantinga
- Division of Geriatrics and Gerontology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Valerie Mac
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Vicki S Hertzberg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Delclos GL. Pilot study determining the feasibility of implementing the Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol, point-of-care field measurements and a new module on risk factors for chronic kidney disease of unknown origin in Hispanic outdoor workers. BMC Nephrol 2021; 22:88. [PMID: 33711949 PMCID: PMC7953681 DOI: 10.1186/s12882-021-02288-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To field test the Disadvantaged Populations eGFR Epidemiology (DEGREE) protocol, outdoor point-of-care (POC) testing for serum creatinine, and a new risk factor module on chronic kidney disease of undetermined origin (CKDu) in U.S. outdoor Hispanic workers. METHODS Fifty workers were interviewed in Houston (TX). DEGREE and CKDu questionnaires were completed indoors. Anthropometrics and paired blood samples for POC and laboratory assay were completed outdoors over two periods (November-December 2017, April-May 2018). RESULTS Administration of DEGREE and CKDu questionnaires averaged 10 and 5 min, respectively, with all questions easily understood. We observed high correlations between POC and IDMS creatinine (r = 0.919) and BUN (r = 0.974). The POC device would disable testing when outdoor temperatures were above 85 °F or below 65 °F; this was adjustable. CONCLUSIONS Implementation of DEGREE and the new CKDu module was straightforward and well understood. The POC device performed well in the field, with some adjustment in methods when temperature readings were out of range.
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Affiliation(s)
- Erika Figueroa-Solis
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
| | - David Gimeno Ruiz de Porras
- grid.267309.90000 0001 0629 5880Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - George L. Delclos
- grid.267308.80000 0000 9206 2401Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
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Schlader ZJ, Hostler D, Parker MD, Pryor RR, Lohr JW, Johnson BD, Chapman CL. The Potential for Renal Injury Elicited by Physical Work in the Heat. Nutrients 2019; 11:nu11092087. [PMID: 31487794 PMCID: PMC6769672 DOI: 10.3390/nu11092087] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
An epidemic of chronic kidney disease (CKD) is occurring in laborers who undertake physical work in hot conditions. Rodent data indicate that heat exposure causes kidney injury, and when this injury is regularly repeated it can elicit CKD. Studies in humans demonstrate that a single bout of exercise in the heat increases biomarkers of acute kidney injury (AKI). Elevations in AKI biomarkers in this context likely reflect an increased susceptibility of the kidneys to AKI. Data largely derived from animal models indicate that the mechanism(s) by which exercise in the heat may increase the risk of AKI is multifactorial. For instance, heat-related reductions in renal blood flow may provoke heterogenous intrarenal blood flow. This can promote localized ischemia, hypoxemia and ATP depletion in renal tubular cells, which could be exacerbated by increased sodium reabsorption. Heightened fructokinase pathway activity likely exacerbates ATP depletion occurring secondary to intrarenal fructose production and hyperuricemia. Collectively, these responses can promote inflammation and oxidative stress, thereby increasing the risk of AKI. Equivalent mechanistic evidence in humans is lacking. Such an understanding could inform the development of countermeasures to safeguard the renal health of laborers who regularly engage in physical work in hot environments.
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Affiliation(s)
- Zachary J Schlader
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA.
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN 47405, USA.
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Mark D Parker
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - James W Lohr
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Blair D Johnson
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Christopher L Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
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