Abstract: FR-PO1130
Insights into Mesoamerican Nephropathy: A Case Report of Environmental and Occupational Influences on CKD
Session Information
- CKD: Epidemiology, Risk Factors, and Prevention - 2
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Shivani, Fnu, Ascension Saint Joseph - Chicago, Chicago, Illinois, United States
- Lohana, Abhi, Camden Clark Medical Center, Parkersburg, West Virginia, United States
- Neel, Sejal, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey, United States
Introduction
In the last 20 years, distinctive forms of chronic kidney disease (CKD) have emerged, unrelated to conventional risk factors like diabetes or hypertension. These diseases, termed as chronic kidney disease of undetermined cause (CKDu), are named after their geographical prevalence, such as Sri Lanka nephropathy or Mesoamerican nephropathy (MeN). Recent studies suggest a combination of environmental and occupational risk factors significantly contribute to the etiology of MeN, including high temperatures, excessive heat stress, agrochemicals, and environmental pollutants.
Case Description
A 40-year-old male from Nicaragua with a past medical history of hypertension presented to the ED with complaints of tingling and numbness in his hands and feet. On arrival, the patient's lab work was remarkable for hyponatremia, hypokalemia, hypocalcemia, hypophosphatemia, hypomagnesemia, elevated creatinine, and BUN. Renal ultrasound showed echogenic kidneys. During the hospital stay, the patient's electrolyte derangements were corrected, but his creatinine consistently stayed around 8.5 mg/dL. The patient's urinalysis was remarkable for nephrotic range proteinuria with normal serum albumin. Extensive workups for renal failure, including autoimmune and infectious markers, were unremarkable. Eventually, a kidney biopsy was done, which showed chronic tubule-interstitial injury being more prominent than glomerular sclerosis, suggesting secondary focal segmental glomerular sclerosis (FSGS), raising suspicion of Mesoamerican nephropathy due to the patient's Nicaraguan origin.
Discussion
Mesoamerican Nephropathy (MeN) is an emerging form of chronic kidney disease prevalent among young males of low socioeconomic status and agricultural workers in hot climates, particularly in Central America. While its exact cause remains unknown, factors such as high temperatures, dehydration, excessive NSAID use, and exposure to pollutants and agrochemicals are associated with MeN development. The chronic tubule-interstitial injury observed in the patient's kidney biopsy aligns with the established understanding of MeN as a condition characterized by tubulointerstitial damage. Studies suggest dehydration-induced acute kidney injury and NSAID overuse contribute to tubulointerstitial nephritis, and disruptions in electrolyte balance worsen MeN progression.