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Chang CJ, Yang HY. Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study. Kidney Int Rep 2023; 8:2677-2689. [PMID: 38106601 PMCID: PMC10719565 DOI: 10.1016/j.ekir.2023.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure. Methods A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination. Results We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR = 1.09, 95% confidence interval [CI] = 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR = 1.023, 95% CI = 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics. Conclusions Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.
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Affiliation(s)
- Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Population Health and Welfare Research Center, National Taiwan University College of Public Health, Taipei, Taiwan
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Schreurs G, Maudsley S, Nast C, Praet M, Da Silva Fernandes S, Boor P, D'Haese P, De Broe ME, Vervaet BA. Chronic dehydration induces injury pathways in rats, but does not mimic histopathology of chronic interstitial nephritis in agricultural communities. Sci Rep 2023; 13:18119. [PMID: 37872220 PMCID: PMC10593944 DOI: 10.1038/s41598-023-43567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
CINAC-patients present renal proximal tubular cell lysosomal lesions which are also observed in patients experiencing calcineurin inhibitor (CNI) nephrotoxicity, suggesting that CINAC is a toxin-induced nephropathy. An alternative hypothesis advocates chronic dehydration as a major etiological factor for CINAC. Here, we evaluated histological and molecular changes in dehydrated versus toxin exposed rats. Wistar rats were divided in 3 groups. Group 1 (n = 6) had free access to drinking water (control group). Group 2 (n = 8) was water deprived for 10 h per 24 h, 5 days/week and placed in an incubator (37 °C) for 30 min/h during water deprivation. Group 3 (n = 8) underwent daily oral gavage with cyclosporine (40 mg/kg body weight). After 28 days, renal function, histopathology and proteomic signatures were analysed. Cyclosporine-treated rats developed focal regions of atrophic proximal tubules with associated tubulo-interstitial fibrosis. PASM staining revealed enlarged argyrophilic granules in affected proximal tubules, identified as lysosomes by immunofluorescent staining. Electron microscopy confirmed the enlarged and dysmorphic phenotype of the lysosomes. Overall, these kidney lesions resemble those that have been previously documented in farmers with CINAC. Dehydration resulted in none of the above histopathological features. Proteomic analysis revealed that dehydration and cyclosporine both induce injury pathways, yet of a clear distinct nature with a signature of toxicity only for the cyclosporine group. In conclusion, both cyclosporine and dehydration are injurious to the kidney. However, dehydration alone does not result in kidney histopathology as observed in CINAC patients, whereas cyclosporine administration does. The histopathological analogy between CINAC and calcineurin inhibitor nephrotoxicity in rats and humans supports the involvement of an as-yet-unidentified environmental toxin in CINAC etiology.
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Affiliation(s)
- Gerd Schreurs
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Stuart Maudsley
- Receptor Biology Lab, Department of Biomedical Science, University of Antwerp, Antwerp, Belgium
| | | | - Marleen Praet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | | | - Peter Boor
- Institute of Pathology, Electron Microscopy Facility and Division of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Patrick D'Haese
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Marc E De Broe
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Benjamin A Vervaet
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium.
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.
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Marín-Medina A, Gómez-Ramos JJ, Mendoza-Morales N, Figuera-Villanueva LE. Association between the Polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 Gene with Chronic Kidney Disease of Uncertain or Non-Traditional Etiology in Mexican Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:829. [PMID: 37241060 PMCID: PMC10221284 DOI: 10.3390/medicina59050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Chronic Kidney Disease of uncertain or non-traditional etiology (CKDnT) is a form of chronic kidney disease of undetermined etiology (CKDu) and is not associated with traditional risk factors. The aim of this study was to investigate the association of polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 gene with CKDnT in Mexican patients. Materials and Methods: We included 105 patients with CKDnT and 90 controls. Genotyping was performed by PCR-RFLP's, genotypic and allelic frequencies were determined and compared between the two groups using χ2 analysis, and differences were expressed as odd ratios with 95% confidence intervals (CI). Values of p < 0.05 were considered statistically significant. Results: Overall, 80% of patients were male. The rs1799983 polymorphism in NOS3 was found to be associated with CKDnT in the Mexican population (p = 0.006) (OR = 0.397; 95% CI, 0.192-0.817) under a dominant model. The genotype frequency was significantly different between the CKDnT and control groups (χ2 = 8.298, p = 0.016). Conclusions: The results of this study indicate that there is an association between the rs2070744 polymorphism and CKDnT in the Mexican population. This polymorphism can play an important role in the pathophysiology of CKDnT whenever there is previous endothelial dysfunction.
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Affiliation(s)
- Alejandro Marín-Medina
- Departamento de Biología Molecular y Genómicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
| | - José Juan Gómez-Ramos
- Departamento de Urgencias, Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
| | - Norberto Mendoza-Morales
- Departamento de Urgencias, Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
- Programa de Especialización en Medicina de Urgencias, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
| | - Luis Eduardo Figuera-Villanueva
- Departamento de Biología Molecular y Genómicas, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdeG), Guadalajara 44100, Jalisco, Mexico
- Centro de Investigación Biomédica de Occidente (CIBO), Instituto Mexicano del Seguro Social, Guadalajara 44100, Jalisco, Mexico
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Cerón A. Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085532. [PMID: 37107814 DOI: 10.3390/ijerph20085532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009-2019 period for each of the country's 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009-2019 period. Average crude mortality rate for all ages for the country's 340 municipalities was 70.66 per 100,000 [0-502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala.
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Affiliation(s)
- Alejandro Cerón
- Department of Anthropology, University of Denver, Denver, CO 80208, USA
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Martins GKDM, Pereira NC, Cunha NVD, Agostinetto L. Exposure of patients with chronic kidney disease on dialysis to pesticides. J Bras Nefrol 2023; 45:169-179. [PMID: 36074120 PMCID: PMC10627121 DOI: 10.1590/2175-8239-jbn-2022-0030en] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pesticides can trigger kidney disease. OBJECTIVE To describe the exposure to pesticides of patients with chronic kidney disease on dialysis. METHODS Quantitative and descriptive field research, with 90 patients with chronic kidney disease on dialysis in two hemodialysis units in the state of Santa Catarina, through the application of a structured questionnaire. Participants were divided into two groups: with and without exposure to pesticides. The questionnaire was applied in hemodialysis clinics during treatment. Laboratory test values were collected from clinical records. Data were analyzed using descriptive statistics and association using the chi-square test. For laboratory test data, a comparison of means was performed using the unpaired Student's t-test between the groups. RESULTS The mean age of exposed participants was 58 years (±13.7; minimum = 23; maximum = 75) and that of non-exposed participants was 64 years old (±13.9; minimum = 35; maximum = 96). Of the 90 patients, 30% were exposed to pesticides. The mean exposure time was 6.7 ± 3.8 hours/day. There was a statistically significant association between the preparation of the mixture with pesticides and diabetes (p ≤ 0.048). There was no statistically significant difference between the results of laboratory tests in the exposed and non-exposed groups. CONCLUSION This study shows that pesticides can be triggering factors for chronic kidney disease (CKD); however, we must expand research in this field to prove the relationship between exposure to pesticides and CKD.
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Affiliation(s)
| | | | - Natália Veronez da Cunha
- Universidade do Planalto Catarinense, Programa de Pós-Graduação em Ambiente e Saúde, Lages, SC, Brasil
| | - Lenita Agostinetto
- Universidade do Planalto Catarinense, Programa de Pós-Graduação em Ambiente e Saúde, Lages, SC, Brasil
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Martins GKDM, Pereira NC, Cunha NVD, Agostinetto L. Exposição de pacientes com doença renal crônica em tratamento dialítico aos agrotóxicos. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0030pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: O uso de agrotóxicos pode desencadear doença renal. Objetivo: Descrever a exposição a agrotóxicos de pacientes com doença renal crônica em tratamento dialítico. Métodos: Pesquisa de campo, quantitativa e descritiva, com 90 portadores de doença renal crônica em tratamento dialítico em duas unidades de hemodiálise no estado de Santa Catarina, por meio da aplicação de um questionário estruturado. Os participantes foram divididos em dois grupos: sem e com exposição a agrotóxicos. O questionário foi aplicado nas clínicas de hemodiálise durante o tratamento. Foram coletados valores de exames laboratoriais dos prontuários clínicos. Os dados foram analisados pela estatística descritiva e associação pelo teste qui-quadrado. Para os dados dos exames laboratoriais, foi realizada comparação de médias pelo teste t de Student não pareado entre os grupos. Resultados: A idade média dos participantes expostos foi de 58 anos (±13,7; mínimo = 23; máximo = 75) e a dos não expostos, de 64 anos (±13,9; mínimo = 35; máximo = 96). Dos 90 pacientes, 30% foram expostos a agrotóxicos. O tempo médio de exposição foi de 6,7 ± 3,8 horas/dia. Houve associação estatística significativa entre o preparo da calda com agrotóxicos e a presença de diabetes (p ≤ 0,048). Não houve diferença estatística significativa entre os resultados dos exames laboratoriais do grupo exposto e do não exposto. Conclusão Esta pesquisa evidencia que os agrotóxicos podem ser fatores desencadeadores da doença renal crônica (DRC), entretanto sugere-se ampliar pesquisas na área que possam comprovar a relação entre exposição a agrotóxicos e DRC.
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Lou-Meda R, Alvarez-Elías AC, Bonilla-Félix M. Mesoamerican Endemic Nephropathy (MeN): A Disease Reported in Adults That May Start Since Childhood? Semin Nephrol 2022; 42:151337. [PMID: 37028147 DOI: 10.1016/j.semnephrol.2023.151337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Mesoamerican endemic nephropathy (MeN) is a type of chronic kidney disease (CKD) of uncertain etiology that occurs along the Pacific coast of the southern part of Mexico and Central America. During the past 20 years MeN has become a leading cause of death in the region, clamming close to 50,000 lives, with 40% of these deaths occurring in young people. The cause remains unknown, but most researchers believe in a multifactorial etiology that includes social determinants of poverty. Existing evidence suggests that subclinical kidney injury begins early in life and leads to a higher than expected prevalence of CKD among children in Central America. Access to health services in the region, specifically kidney replacement therapy, remains limited. We proposed a strategy to address the perceived needs and urge coordinated efforts of governments, academic organizations, and international bodies to develop a comprehensive plan of action to mitigate this situation among the vulnerable and economically disadvantaged population.
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Affiliation(s)
- Randall Lou-Meda
- Pediatric Nephrology Unit, Fundacion Para el Niño Enfermo Renal (FUNDANIER), Guatemala City, Guatemala; Department of Pediatrics, Hospital Roosevelt, Guatemala City, Guatemala.
| | - Ana Catalina Alvarez-Elías
- Nephrology Division, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Health Policy and Management, University of Toronto, Ontario, Canada; Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Melvin Bonilla-Félix
- Pediatric Nephrology Division, Hospital Pediátrico Universitario, San Juan, Puerto Rico; Universidad de Puerto Rico, San Juan, Puerto Rico
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Lee J, Lee I, Park JY, Kim S, Park H, Jung SK, Lee C, Lee JP, Choi K. Exposure to several polychlorinated biphenyls (PCBs) is associated with chronic kidney disease among general adults: Korean National Environmental Health Survey (KoNEHS) 2015-2017. CHEMOSPHERE 2022; 303:134998. [PMID: 35597461 DOI: 10.1016/j.chemosphere.2022.134998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/08/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
We investigated the association between major persistent organic pollutants (POPs) exposure and chronic kidney disease (CKD) among general adult population of Korea. For this purpose, a subset of the adult population (n = 1276) participated in Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015-2017) were analyzed for twenty-four POPs in serum, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs), and were derived for estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR). Multivariable linear regression was conducted to assess the association between POPs exposure and CKD-related parameters including eGFR and uACR. As sensitivity analyses, principal component analysis was conducted. Moreover, the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2004 data were chosen to compare with the observations of the Korean adults. Approximately 7.7% of the Korean adult population possessed CKD based on either eGFR (<60 ml/min/1.73 m2) or uACR (≥30 mg/g) criteria. Among the POPs that were detected in ≥70% of the subjects, PCB153 (β = -1.61, 95% CI: -2.55, -0.67, P = 0.001) and PCB180 (β = -1.47, 95% CI: -2.53, -0.40, P = 0.007) exhibited significant associations with decreased eGFR, especially in females. In male participants, hexachlorobenzene (HCB) was associated with eGFR (β = -0.79, 95% CI: -1.53, -0.04, P = 0.040). Sex-dependent associations with eGFR were also shown in the PCA model. Moreover, the sex-dependent associations of PCBs were similarly observed in the adult populations of the US NHANES. However, POPs exposure was not associated with uACR, regardless of association model or population. The observed associations of PCBs are supported by several experimental studies reported elsewhere. To our knowledge, it is the first report that suggests significant associations of PCBs and HCB with eGFR among general population, and further validations in other populations are warranted.
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Affiliation(s)
- Jeonghwan Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inae Lee
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Gyeongju, Republic of Korea
| | - Sunmi Kim
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Chemical Safety Research Center, Korea Research Institute of Chemical Technology, Daejeon, South Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sun Kyoung Jung
- Environmental Health Research Division, National Institute of Environmental Research, Ministry of Environment, Incheon, 22689, Republic of Korea
| | - Chulwoo Lee
- Environmental Health Research Division, National Institute of Environmental Research, Ministry of Environment, Incheon, 22689, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Seoul National University Kidney Research Institute, Seoul, 03080, Republic of Korea.
| | - Kyungho Choi
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea; Institute of Health and Environment, Seoul National University, Seoul, 08826, Republic of Korea.
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Crowe J, Rojas-Valverde D, Rojas-Garbanzo M, Gutiérrez-Vargas R, Ugalde-Ramírez JA, Ledezma-Rojas JP, Cabrera-Alpizar W, Salazar-Salazar M, Mauricio-La Torre R, Valera-Amador L, van Wendel de Joode B. Kidney Function in Rice Workers Exposed to Heat and Dehydration in Costa Rica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094962. [PMID: 35564355 PMCID: PMC9100597 DOI: 10.3390/ijerph19094962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022]
Abstract
The aim of this study was to evaluate heat exposure, dehydration, and kidney function in rice workers over the course of three months, in Guanacaste, Costa Rica. We collected biological and questionnaire data across a three-month-period in male field (n = 27) and other (n = 45) workers from a rice company where chronic kidney disease of unknown origin (CKDu) is endemic. We used stepwise forward regression to determine variables associated with estimated glomerular filtration rate eGFR at enrollment and/or change in eGFR, and Poisson regression to assess associations with incident kidney injury (IKI) over the course of three months. Participants were 20−62 years old (median = 40 in both groups). Dehydration was common (≥37%) in both groups, particularly among other workers at enrollment, but field workers were more exposed to heat and had higher workloads. Low eGFR (<60 mL/min/1.73 m2) was more prevalent in field workers at enrollment (19% vs. 4%) and follow-up (26% vs. 7%). Field workers experienced incident kidney injury (IKI) more frequently than other workers: 26% versus 2%, respectively. Age (β = −0.71, 95%CI: −1.1, −0.4), current position as a field worker (β = −2.75, 95%CI: −6.49, 0.99) and past work in construction (β = 3.8, 95%CI: −0.1, 7.6) were included in the multivariate regression model to explain eGFR at enrollment. The multivariate regression model for decreased in eGFR over three month included current field worker (β = −3.9, 95%CI: −8.2, 0.4), current smoking (β= −6.2, 95%CI: −13.7−1.3), dehydration (USG ≥ 1.025) at both visits (β= −3.19, 95%CI: −7.6, 1.2) and pain medication at follow-up (β= −3.2, 95%CI: −8.2, 1.95). Current fieldwork [IR (incidence rate) = 2.2, 95%CI 1.1, 5.8) and being diabetic (IR = 1.8, 95%CI 0.9, 3.6) were associated with IKI. Low eGFR was common in field workers from a rice company in Guanacaste, and being a field worker was a risk factor for IKI, consistent with the hypothesis that occupational heat exposure is a critical risk factor for CKDu in Mesoamerica.
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Affiliation(s)
- Jennifer Crowe
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
- Correspondence:
| | - Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - Marianela Rojas-Garbanzo
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
| | - Randall Gutiérrez-Vargas
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - José Alexis Ugalde-Ramírez
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - José Pablo Ledezma-Rojas
- Masters Program in Occupational Health, Universidad Nacional-Instituto Tecnológico de Costa Rica, Heredia 40101, Costa Rica;
| | - William Cabrera-Alpizar
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | | | | | | | - Berna van Wendel de Joode
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
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Suriyong P, Ruengorn C, Shayakul C, Anantachoti P, Kanjanarat P. Prevalence of chronic kidney disease stages 3-5 in low- and middle-income countries in Asia: A systematic review and meta-analysis. PLoS One 2022; 17:e0264393. [PMID: 35213610 PMCID: PMC8880400 DOI: 10.1371/journal.pone.0264393] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/09/2022] [Indexed: 01/14/2023] Open
Abstract
Chronic kidney disease (CKD) is a major public health problem in low- and middle-income countries (LMICs). Although CKD prevalence has been rapidly increasing in LMICs, particularly in Asia, quantitative studies on the current epidemiology of CKD in this region are limited. This study aimed to identify the prevalence of CKD stages 3-5 in LMICs in Asia, by subregion, country economy classification, identification of CKD, traditional and non-traditional risk factors. A systematic review and meta-analysis of observational studies was conducted through a literature search of seven electronic databases and grey literature search published until November 2021. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the risk of bias of each study. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019120519). Of 4,548 potentially relevant records, 110 studies with moderate and high quality were included with 4,760,147 subjects. The average prevalence (95% CI) of CKD stages 3-5 in 14 LMICs in Asia was 11.2% (9.3-13.2%). The prevalence of CKD stages 3-5 was varied among subregions and country economic classification. CKD prevalence was 8.6% (7.2-10.2%) in east Asia, 12.0% (7.7-17.0%) in south-east Asia, 13.1% (8.7-18.2%) in western Asia, and 13.5% (9.5-18.0%) in south Asia. CKD prevalence was 9.8% (8.3-11.5%) in upper-middle-income countries and 13.8% (9.9-18.3%) in lower-middle-income countries. Prevalence of CKD stage 3-5 in LMICs in Asia is comparable to global prevalence. High level of heterogeneity was observed. Study of factors and interventions that lead to the delay of CKD progression is needed.
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Affiliation(s)
- Pongpan Suriyong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chairat Shayakul
- Renal Division, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Puree Anantachoti
- Social and Administrative Pharmacy Department, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Penkarn Kanjanarat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
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11
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Jalili C, Kazemi M, Cheng H, Mohammadi H, Babaei A, Taheri E, Moradi S. Associations between exposure to heavy metals and the risk of chronic kidney disease: a systematic review and meta-analysis. Crit Rev Toxicol 2021; 51:165-182. [PMID: 33960873 DOI: 10.1080/10408444.2021.1891196] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We performed a systematic review and meta-analysis to examine the relationship between heavy metals (HMs) exposure and the risk of chronic kidney disease (CKD). Databases of Web of Science, Embase, MEDLINE, and Scopus were searched through June 2020 to identify studies assessing the relationships between exposure to HMs (i.e. cadmium, lead, arsenic, mercury) and the risk of CKD, evaluated by decreased estimated glomerular filtration rate (eGFR) and/or increased proteinuria risks in adults (≥18 years). Data were pooled by random-effects models and expressed as weighted mean differences and 95% confidence intervals. The risk of bias was assessed by the Newcastle-Ottawa scale (NOS). Twenty-eight eligible articles (n = 107,539 participants) were included. Unlike eGFR risk (p = 0.10), Cadmium exposure was associated with an increased proteinuria risk (OR = 1.35; 95% CI: 1.13, 1.61; p < 0.001; I2 = 79.7%). Lead exposure was associated with decreased eGFR (OR = 1.12; 95%CI: 1.03, 1.22; p = 0.008; I2 = 87.8%) and increased proteinuria (OR = 1.25; 95% CI: 1.04, 1.49; p = 0.02; I2 = 79.6) risks. Further, arsenic exposure was linked to a decreased eGFR risk (OR = 1.55; 95% CI: 1.05, 2.28; p = 0.03; I2 = 89.1%) in contrast to mercury exposure (p = 0.89). Only two studies reported the link between arsenic exposure and proteinuria risk, while no study reported the link between mercury exposure and proteinuria risk. Exposure to cadmium, lead, and arsenic may increase CKD risk in adults, albeit studies were heterogeneous, warranting further investigations. Our observations support the consideration of these associations for preventative, diagnostic, monitoring, and management practices of CKD.
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Affiliation(s)
- Cyrus Jalili
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Kazemi
- Division of Nutritional Sciences, Human Metabolic Research Unit, Cornell University, New York, USA
| | - Hefa Cheng
- MOE Key Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefeh Babaei
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ensiyeh Taheri
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Halal Research Center of IRI, FDA, Tehran, Iran
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12
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Vervaet BA, Nast CC, Schreurs G, Jayasumana C, Herath C, Kojc N, De Broe ME. Chronic interstitial nephritis in agricultural communities: a new perspective on etiology, diagnosis and mechanism. Nephrol Ther 2021; 17S:S45-S50. [PMID: 33910697 DOI: 10.1016/j.nephro.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 01/26/2023]
Abstract
Chronic interstitial nephritis in agricultural communities is a devastating kidney disease with a globally increasing prevalence. Its cause is unknown. Two predominant etiologies are hypothesised: recurrent episodes of dehydration and exposure to environmental toxins, such as agrochemicals and metals. In this review, we summarise arguments on: 1) why heat stress/dehydration is an unlikely cause of this disease and 2) why chronic interstitial nephritis in agricultural communities is to be considered a toxin-induced nephropathy. Mechanistically, we provide arguments for a putative role of pesticides on the one hand, and the calcineurin pathway on the other hand, both of which require further investigation. Finally, we summarise several important perspectives for research on chronic interstitial nephritis in agricultural communities.
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Affiliation(s)
- Benjamin A Vervaet
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | | | - Gerd Schreurs
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Channa Jayasumana
- Faculty of Medicine, Rajatrata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Chula Herath
- Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | - Nika Kojc
- Department of Pathology, University of Ljubljana, Ljubljana, Slovenia
| | - Marc E De Broe
- Laboratory of Pathophysiology, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
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Renal Failure among Women of Reproductive Age in Burundi: Estimating the Prevalence and Associated Factors Using Population-Based Data. Int J Nephrol 2021; 2021:6640495. [PMID: 33728065 PMCID: PMC7936884 DOI: 10.1155/2021/6640495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Renal failure is a leading cause of morbidity and mortality in many resource-constrained settings. In developing countries, little has been known about the prevalence and predisposing factors of renal failure using population-based data. The objective of this study was to examine the prevalence and associated factors of renal failure among women of reproductive age in Burundi. Methods We used nationally representative cross-sectional data from the 2016-2017 Burundi Demographic and Health Survey (BDHS). Data on 17,269 women of reproductive age were included. The outcome variable was a renal failure as determined by the patient's report. Percentage, chi-square test, and multivariable logistic regression model were used to analyze the data. The results from the logistic regression model were presented as adjusted odds ratio (AOR) and confidence interval (95% CI). The significance level was set at p < 0.05. Results The overall prevalence of renal failure was 5.0% (95% CI: 4.4%, 5.7%). Higher-aged women were more likely to have a renal failure when compared with women aged 15-19 years. Rural dwellers were 1.65 times as likely to have a renal failure when compared with women in the urban residence (AOR = 1.65; 95% CI: 1.24, 2.20). Women who had secondary + education had a 39% reduction in the odds of renal failure when compared with women with no formal education (AOR = 0.61; 95% CI: 0.46, 0.81). Health insurance coverage accounted for a 23% reduction in the odds of renal failure when compared with women who were not covered by health insurance (AOR = 0.77; 95% CI: 0.63, 0.93). Women who had a terminated pregnancy were 1.50 times as likely to have a renal failure when compared with women with no history of terminated pregnancy (AOR = 1.50; 95% CI: 1.24, 1.82). Furthermore, women with a history of contraceptive use were 1.32 times as likely to have a renal failure when compared with women without a history of contraceptive use (AOR = 1.32; 95% CI: 1.11, 1.57). Conclusion Lack of formal education, having no health insurance coverage, and ever used anything or tried to delay or avoid getting pregnant were the modifiable risk factors of renal failure. The nonmodifiable risk factors were old age, rural residence, certain geographical regions, and having a history of pregnancy termination. Understanding the risk factors of renal failure will help to instigate early screening, detection, and prompt treatment initiation. In addition, early detection of the risk factors can help to reduce the adverse health impact including maternal death.
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Cerón A, Ramay BM, Méndez-Alburez LP, Lou-Meda R. Factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. Rev Panam Salud Publica 2021; 45:e24. [PMID: 33727908 PMCID: PMC7954194 DOI: 10.26633/rpsp.2021.24] [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: 06/23/2020] [Accepted: 10/18/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. METHODS A cross-sectional survey was conducted. The study population was all pediatric patients with stage 5 chronic kidney disease active in FUNDANIER's pediatric nephrology unit (N = 156). Simple random sampling led to a total of 100 participants. Data collection consisted of a questionnaire addressing individual and household characteristics, access and utilization of health care, and place of residence when the disease began. Chronic kidney disease etiology was obtained from medical records. Municipality-level secondary data were collected. Descriptive statistics were estimated. Logistic regression was used for bivariate and multivariate analysis. RESULTS The odds ratio (OR) for almost all variables approached 1. Notable exceptions in household characteristics were mother's education level up to primary school (OR 2.2727) and living in an urban setting when symptoms began (OR 0.4035). Exceptions in municipal characteristics are zones with intensive small-scale agriculture (OR 3.8923) and those with intensive large-scale agriculture (OR 0.3338). P-values and confidence intervals show that the sample was not big enough to capture statistically significant associations between variables. CONCLUSIONS Study findings suggest that factors associated with chronic kidney disease of non-traditional causes among children in Guatemala are intensive agricultural practices in their municipality of residence, and mother's level of education. Future research in children could use case-control designs or population-based studies in agricultural communities. Public health interventions that involve kidney function screening among children are recommended.
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Affiliation(s)
- Alejandro Cerón
- University of DenverDenver, COUnited States of AmericaUniversity of Denver, Denver, CO, United States of America
| | - Brooke M. Ramay
- Universidad del Valle de GuatemalaGuatemala CityGuatemalaUniversidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Luis Pablo Méndez-Alburez
- Universidad Maya KaqchikelChimaltenangoGuatemalaUniversidad Maya Kaqchikel, Chimaltenango, Guatemala
| | - Randall Lou-Meda
- Fundación para el Niño Enfermo Renal—FUNDANIERGuatemala CityGuatemalaFundación para el Niño Enfermo Renal—FUNDANIER, Guatemala City, Guatemala
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15
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Cerón A, Ramay BM, Méndez-Alburez LP, Randall R. Factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. Rev Panam Salud Publica 2021. [DOI: 10.26633/rpsp.2020.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. To identify factors associated with chronic kidney disease of non-traditional causes among children in Guatemala.
Methods. A cross-sectional survey was conducted. The study population was all pediatric patients with stage 5 chronic kidney disease active in FUNDANIER’s pediatric nephrology unit (N = 156). Simple random sampling led to a total of 100 participants. Data collection consisted of a questionnaire addressing individual and household characteristics, access and utilization of health care, and place of residence when the disease began. Chronic kidney disease etiology was obtained from medical records. Municipality-level secondary data were collected. Descriptive statistics were estimated. Logistic regression was used for bivariate and multivariate analysis.
Results. The odds ratio (OR) for almost all variables approached 1. Notable exceptions in household characteristics were mother’s education level up to primary school (OR 2.2727) and living in an urban setting when symptoms began (OR 0.4035). Exceptions in municipal characteristics are zones with intensive small-scale agriculture (OR 3.8923) and those with intensive large-scale agriculture (OR 0.3338). P-values and confidence intervals show that the sample was not big enough to capture statistically significant associations between variables.
Conclusions. Study findings suggest that factors associated with chronic kidney disease of non-traditional causes among children in Guatemala are intensive agricultural practices in their municipality of residence, and mother’s level of education. Future research in children could use case-control designs or population-based studies in agricultural communities. Public health interventions that involve kidney function screening among children are recommended.
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Affiliation(s)
| | - Brooke M. Ramay
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Randall Randall
- Fundación para el Niño Enfermo Renal—FUNDANIER, Guatemala City, Guatemala
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16
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Sena A, Ebi K. When Land Is Under Pressure Health Is Under Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E136. [PMID: 33375481 PMCID: PMC7796245 DOI: 10.3390/ijerph18010136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/04/2022]
Abstract
The land provides vital resources to support life on Earth. Land ecosystems services have social, cultural, and spiritual benefits and promote human health and well-being. However, human activities, particularly ongoing unsustainable land practices, are negatively impacting ecosystems through desertification, land degradation and drought (DLDD). This article highlights the pressures and impacts of DLDD on human health through exposure pathways, including water security and safety; sanitation and hygiene; food security and safety; air quality; and soil quality. We describe the impacts on 19 health outcomes in three groups: non-communicable diseases; injuries; and infections, parasitic and nutritional diseases. The magnitude of these health impacts is mediated by social, economic, and health system-related factors. We propose actions for the health sector to respond to the DLDD challenges.
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Affiliation(s)
- Aderita Sena
- Centre of the Study and Research of Health Emergencies and Disasters, Oswaldo Cruz Foundation, Rio de Janeiro 21040-361, Brazil
| | - Kristie Ebi
- Department of Global Health, University of Washington, Seattle, Washington, WA 98195, USA;
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17
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De Broe ME, Vervaet BA. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? PRO. KIDNEY360 2020; 1:591-595. [PMID: 35372944 PMCID: PMC8815546 DOI: 10.34067/kid.0003172020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/11/2020] [Indexed: 05/17/2023]
Affiliation(s)
- Marc E. De Broe
- Laboratory of Pathophysiology, University of Antwerp, Antwerp, Belgium
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18
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Wesseling C. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? CON. KIDNEY360 2020; 1:596-601. [PMID: 35372936 PMCID: PMC8815562 DOI: 10.34067/kid.0002922020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/17/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Catharina Wesseling
- La Isla Network, Washington, DC
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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19
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Wesseling C, Glaser J, Rodríguez-Guzmán J, Weiss I, Lucas R, Peraza S, da Silva AS, Hansson E, Johnson RJ, Hogstedt C, Wegman DH, Jakobsson K. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica 2020; 44:e15. [PMID: 31998376 PMCID: PMC6984407 DOI: 10.26633/rpsp.2020.15] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022] Open
Abstract
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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Affiliation(s)
- Catharina Wesseling
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - Jason Glaser
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Julieta Rodríguez-Guzmán
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Ilana Weiss
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Rebekah Lucas
- University of BirminghamUniversity of BirminghamBirminghamUnited KingdomUniversity of Birmingham, Birmingham, United Kingdom
| | - Sandra Peraza
- University of El SalvadorUniversity of El SalvadorSan SalvadorEl SalvadorUniversity of El Salvador, San Salvador, El Salvador
| | - Agnes Soares da Silva
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Erik Hansson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
| | - Richard J. Johnson
- University of Colorado at DenverUniversity of Colorado at DenverAuroraUnited States of AmericaUniversity of Colorado at Denver, Aurora, United States of America
| | - Christer Hogstedt
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - David H. Wegman
- University of Massachusetts LowellUniversity of Massachusetts LowellLowellUnited States of AmericaUniversity of Massachusetts Lowell, Lowell, United States of America
| | - Kristina Jakobsson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
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20
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Rojas-Valverde D, Olcina G, Gutiérrez-Vargas R, Crowe J. Heat Strain, External Workload, and Chronic Kidney Disease in Tropical Settings: Are Endurance Athletes Exposed? Front Physiol 2019; 10:1403. [PMID: 31824329 PMCID: PMC6881241 DOI: 10.3389/fphys.2019.01403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica.,Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Guillermo Olcina
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, Cáceres, Spain
| | - Randall Gutiérrez-Vargas
- Centro de Investigación y Diagnóstico en Salud y Deporte, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional, Heredia, Costa Rica
| | - Jennifer Crowe
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), Universidad Nacional, Heredia, Costa Rica
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21
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Vervaet BA, Nast CC, Jayasumana C, Schreurs G, Roels F, Herath C, Kojc N, Samaee V, Rodrigo S, Gowrishankar S, Mousson C, Dassanayake R, Orantes CM, Vuiblet V, Rigothier C, D'Haese PC, De Broe ME. Chronic interstitial nephritis in agricultural communities is a toxin-induced proximal tubular nephropathy. Kidney Int 2019; 97:350-369. [PMID: 31892415 DOI: 10.1016/j.kint.2019.11.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/09/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
Almost 30 years after the detection of chronic interstitial nephritis in agricultural communities (CINAC) its etiology remains unknown. To help define this we examined 34 renal biopsies from Sri Lanka, El Salvador, India and France of patients with chronic kidney disease 2-3 and diagnosed with CINAC by light and electron microscopy. In addition to known histopathology, we identified a unique constellation of proximal tubular cell findings including large dysmorphic lysosomes with a light-medium electron-dense matrix containing dispersed dark electron-dense non-membrane bound "aggregates". These aggregates associated with varying degrees of cellular/tubular atrophy, apparent cell fragment shedding and no-weak proximal tubular cell proliferative capacity. Identical lysosomal lesions, identifiable by electron microscopy, were observed in 9% of renal transplant implantation biopsies, but were more prevalent in six month (50%) and 12 month (67%) protocol biopsies and in indication biopsies (76%) of calcineurin inhibitor treated transplant patients. The phenotype was also found associated with nephrotoxic drugs (lomustine, clomiphene, lithium, cocaine) and in some patients with light chain tubulopathy, all conditions that can be directly or indirectly linked to calcineurin pathway inhibition or modulation. One hundred biopsies of normal kidneys, drug/toxin induced nephropathies, and overt proteinuric patients of different etiologies to some extent could demonstrate the light microscopic proximal tubular cell changes, but rarely the electron microscopic lysosomal features. Rats treated with the calcineurin inhibitor cyclosporine for four weeks developed similar proximal tubular cell lysosomal alterations, which were absent in a dehydration group. Overall, the finding of an identical proximal tubular cell (lysosomal) lesion in CINAC and calcineurin inhibitor nephrotoxicity in different geographic regions suggests a common paradigm where CINAC patients undergo a tubulotoxic mechanism similar to calcineurin inhibitor nephrotoxicity.
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Affiliation(s)
| | - Cynthia C Nast
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Channa Jayasumana
- Faculty of Medicine, Rajatrata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Gerd Schreurs
- Laboratory of Pathophysiology, University Antwerp, Antwerp, Belgium
| | - Frank Roels
- Department of Pathology, Ghent University, Gent, Belgium
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | - Nika Kojc
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vahid Samaee
- Electron Microscopy for Materials Science (EMAT), University of Antwerp, Antwerp, Belgium
| | - Sonali Rodrigo
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, Sri Lanka
| | | | - Christiane Mousson
- Department of Nephrology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | | | - Carlos M Orantes
- National Institute of Health, Ministry of Health of El Salvador, San Salvador, El Salvador
| | - Vincent Vuiblet
- Departments of Nephrology and Renal Pathology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Claire Rigothier
- Service Néphrologie, Transplantation, Dialyse et Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Marc E De Broe
- Laboratory of Pathophysiology, University Antwerp, Antwerp, Belgium.
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22
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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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