Abstract: FR-OR115

The Prevalence of Mesoamerican Nephropathy in Larreynaga-Malpaisillo, Leon, Nicaragua

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Bianchi, Stefano, ASL NO, Livorno, Italy
  • Bigazzi, Roberto, ASL NO, Livorno, Italy
  • Jimenez penado, Elba Maria, Blood bank - Health MInister, León, Nicaragua
  • Grillo, Andrea, ASL NO, Livorno, Italy
  • Nistri, Francesca, ASL NO, Livorno, Italy
  • Santini, Giada Giovanna, ASL NO, Livorno, Italy
  • Poderelli, Elisa, ASL NO, Livorno, Italy
  • D'Aurizio, Eva, ASL NO, Livorno, Italy
  • Samoni, Sara, ASL NO, Livorno, Italy
  • Cellai, Filippo, ASL NO, Livorno, Italy
Background

An unrelenting epidemic of unexplained chronic kidney disease (CKD) affecting primarily young individuals has been observed throughout Central America. This condition has been called Mesoamerican Nephropathy (MeN). This disease is characterized by elevated serum creatinine, hyperuricemia, leukocyturia, and minimal proteinuria and hematuria. Kidney biopsies are consistent with chronic tubulointerstitial nephritis. The causes of this epidemic remain obscure and systematic epidemiological data are scarse.

Methods

In the context of a joint effort between Regione Toscana and the Department of Leon we performed a screening of the population in the city of Malpaisillo-Larreynaga, in the Department of León, Nicaragua * . Out of a general population of 23885 inhabitants we selected 18510 subjects , age ≥ 12 years, (mean age (± SD) 36.3 ± 18 years , 8771 M, 9739 F), and extracted a sample of 2768 subjects (1310 M, 1458 F), of these 1915 subjects (723 M and 1192 F; mean age 38.9 ± 18) were enrolled . All participants filled a questionnaire and in all of them we collected blood and urine samples to estimate glomerular filtration rate (eGFR) ( CKD-EPI mL/min/1.73m2) , and urine albumin excretion ( UAE= albumin, mg / creatinine, g).

Results

Among participants, 1410 (73.6%; 483 M and 927 F) had normal eGFR, and 505 (26.4%; 240 M and 265 F) manifested CKD (Stage 1=21.6%; Stage 2=14.8%; Stage 3a= 25.5%; Stage 3b=15.8%; Stage 4=16%; Stage 5=6.3%). Males (33.2%) were more affected than females (22.2%). Among participants with CKD Stage 3-5, 160 (~50%) had UAE < 30 and 162 (~50%) had UAE > 30 . Among the latter, only 40 (25%) of subjects manifested UAE > 300. No patient manifested nephrotic syndrome.

Conclusion

For the first time a systematic epidemiological approach to estimate the prevalence of MeN has been used. We report an alarming prevalence of CKD affecting a relatively young population in Malpaisillo-Larreynaga, Leon , Nicaragua. The disease is in large part asymptomatic and characterized by minimal proteinura in keeping with a diagnosis of tubulointerstitial disease. The cause(s) of this disease remain to be determined.
*Perfil epidemiologico de la enfermedad renal cronica y sus principales factores de riesco en el municipio Larreynaga-Malpaisillo, Leon, Nicaragua.

Funding

  • Government Support - Non-U.S.