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Abstract: SA-PO352

Houston Encounters of CKD of Uncertain Origin (CKDu): Lack of Major Etiologic Factor, except for Exposure to Herbicide

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression


  • Espina, Ilse M, Baylor College of Medicine, Houston, Texas, United States
  • Bustamante, Edlyn Geraldine, Harris Health, Houston, Texas, United States
  • Maldonado, Maria Elizabeth, Baylor College of Medicine, Houston, Texas, United States
  • Ceasar, Joniqua Nashae, Baylor College of Medicine, Houston, Texas, United States
  • Dominguez, Jose Rafael, Baylor College of Medicine, Houston, Texas, United States
  • Sheikh-Hamad, David, Baylor College of Medicine, Houston, Texas, United States

CKDu (aka MesoAmerican Nephropathy) is encountered globally. Proposed etiologies for CKDu include dehydration, toxic exposure and infection. To identify possible etiology for CKDu among patients encountered at a safety net hospital in Houston, we carried out chart review of CKD5 patients matching the inclusion criteria for the study.


Thirty patients were identified based on history consistent with CKDu – young, migrant worker, otherwise healthy who presents in renal failure. Patients were included in the study if 1) laboratory studies are consistent with CKD5 (BUN, serum creatinine, Ca/PO4, iPTH and anemia), 2) kidney ultrasound showing small kidneys, 3) urine studies without significant proteinuria or urine sediment, and 4) negative studies for viral hepatitis, syphilis, HIV, ANA, ANCA, SPEP, UPEP. Exclusion criteria: history of diabetes, known primary or secondary renal disease.


10 patients were available for interview. 9/10 male, 1/10 female; 6/10 from Mexico, 3/10 from El Salvador, 1/10 from Honduras. Only one had knowledge of kidney disease upon presentation, 3 had family history of CKD, 4/10 had occasional intake of Tylenol. Mean age at presentation 32.8 years (median: 33, range 25-43). Mean stay in the US before CKD5 diagnosis 9.2 years (median 8, range 1-15). Before immigrating to the US, 7/10 lived in a village/farm, 3/10 lived a city. 8/10 lived in hot climate zones (6/10 mountains, 2 valleys, 2 close to ocean); 4/10 worked in agriculture/farming (8-15 years). While in the US, 6/10 worked in construction, 3/10 in landscaping, 0/10 in farming. Of the 4 farm workers, 2/10 cultivated cane, 2/10 cotton, 3/10 corn, and 2/10 had exposure to animal stock; 3 had chronic intermittent exposure to Gramaxone (paraquat-based herbicide), while 1/10 had exposure to bug killer and fertilizers. 4/10 drank well water, the rest consumed bottled water, and only 2/10 consumed sweetened drinks; uric acid levels were normal (available on 3/10).


Patients with CKDu encountered are migrant workers, male, young, originally from a farm/village, living in hot mountainous regions. Hydration solution consisted of water. We found no clear identifiable risk factors for CKDu except for chronic exposure to Gramaxone/paraquat in farm workers.


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