Causes Mesoamerican nephropathy

1 causes

1.1 multifactorial disease
1.2 cultural pattern
1.3 alcoholism , self-medication
1.4 clinical manifestations
1.5 prevalence of ckdu outside mesoamerica
1.6 heatstress , dehydration

causes

the cause of men unclear, not explained conventional causes such diabetes mellitus or hypertension. many risk factors have been proposed date, causes of disease remain uncertain , controversial.

multifactorial disease

pesticides,
environmental toxins,
well water contamination,
heavy metals,
arsenic , others

have been proposed among possible causes of disease. instance, above-mentioned declaration produced april 2013 international conference took place in san salvador said that:

“while there consensus multifactorial disease, of main factors include exposure agrochemicals, either through direct prolonged exposure on time or through residual long-standing contamination of soil, water sources, , crops, compounded difficult working conditions; exposure high temperatures; , insufficient water intake, among others factors.”

the nature of multifactorial problems is, observed disease can caused regionally different sets of risk factors, e.g. agrochemicals , heavy metals ubiquitous in endemic , non-endemic areas, feature proteinuria, or have not been related ckd acute kidney injury. mesoamerican volcanic soils, instance, rich in arsenic , cadmium (e.g. ckdu miners).

cultural pattern

in central america, cultural pattern men field work while women stay home perform domestic chores; since disease seen in men/workers, has been speculated may related occupation, heat-stress or agrochemicals (particularly pesticides). widespread-environmental or community water contamination cannot explain particular gender/labor pattern; agrochemicals traditionally have been used in these , other farming areas disease not prevalent, specific product – or products combination – not used elsewhere in coastlands should brought consideration pesticides hypothesis offer plausible explanation main culprit.

alcoholism , self-medication

alcoholism , self-medication common features in these populations. nsaids self-prescription particularly widespread, possibly due frequent agricultural work posture-related pains, , dysuria commonly treated aminoglycosides, not related urinary tract infections perhaps associated dehydration itself.

clinical manifestations

published evidence, clinical manifestations, , biopsy findings suggest men new form of ckd, new pathologic entity related repeated heat stress, dehydration, salt depletion, , possibly other contributing factors, nsaids abuse. recent study wild-type mice exposed recurrent dehydration induced heat stress produced similar pattern of kidney injury, providing potential mechanism men, activation of polyol pathway, via metabolism fructokinase, resulting in generation of endogenous fructose , uric acid in kidney subsequently induces renal injury.

prevalence of ckdu outside mesoamerica

adding elements debate, recent study sri lanka, similar , apparently new form of ckdu has become serious public health concern too, suggests chronic synergestic exposure multiple pesticide residues , heavy metal main causal factor. authors hypothesize “agrochemicals essential factor disease“. dr. channa jayasumana, sri lankan researcher, member of medical faculty of rajarata university, has been leading supporter of pesticide hypothesis, in connection hard water consumption. has said research conducted university found “pesticides , chemical fertilizers responsible spike in kidney diseases”, further points out heat stress , dehydration important aggravating factor of disease.

heatstress , dehydration

the same position supported authors of 1 study developed in el salvador, el salvadoran study did not find increased odds ratio ckd in people exposed agrochemical products, or direct evidence linking pesticides. other studies sri lanka have showed chronic exposure of people in agrochemically laden fields low levels of cadmium through food chain , pesticides responsible higher urinary excretion of cadmium in individuals ckdu, urinary cadmium excretion increased in forms of ckd, , cadmium nephropathy highly proteinuric while men not. based on hypothetical possibility, sri lanka has banned many of these chemicals, , el salvador has similar legislation pending, waiting direct evidence linking disease use of agrochemicals in mesoamerican region.

the import , production of agrochemicals can quantified. in addition amount of agrochemicals workflow in agrochemicals applied relevant exposure of workers agrochemical (application tractor or manual work or application of self-protection measures). ckdu has not been reported among workers laboring under supposedly similar heat stress in other tropical areas of world, such brazil, cuba or jamaica, same pesticides may not have been used in same fashion or quantities in mesoamerica. however, heat stress measurements have not been assessed in these countries , cannot compared, , ckd cases underreported, in mesoamerican region before first description of disease in 2002. in case, there important differences between these caribbean , atlantic countries , mesoamerican pacific coastlands, differences including

level of agroindustrial mechanization,
working conditions (access drinking water , rest in shady spots),
easy access nsaids without prescription,
and healthcare accessibility, and
marked ethnic differences - because mesoamerican pacific ocean coastland has little or no black ethnicity influence, being native american mestizos .

a large (nearly 38,000 workers, 5 year follow up) prospective study thailand in 2012 found 5-fold increased risk (adjusted odds ratio) ckd in heat stress exposed workers physical jobs, disease more prevalent around globe first thought, , needs closer look. heat stress hypothesis needs more considered , examined.