Abstract: PUB659
Men in Our Own Backyard: Case Reports of ESRD from Suspected Mesoamerican Nephropathy
Session Information
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Mclaughlin, Susanne Francis, Baylor College of Medicine, Houston, Texas, United States
- Mandayam, Sreedhar A., None, Missouri City, Texas, United States
Background
There is a mysterious cluster of renal failure without obvious etiology in young agricultural workers from Central America. Potential risk factors including pesticide exposure, heat stress, NSAID use, and contaminated water are being implicated. As part of a larger study at Baylor College of Medicine investigating Mesoamerican Nephropathy, we are conducting demographic surveys on immigrant patients with ESRD who come to our ER for dialysis. Here we present a selection of case reports illustrative of Mesoamerican Nephropathy.
Methods
ESRD patients who have emigrated from Mexico or Central America volunteer for a survey about their work and living conditions in their native country. Those with a known cause of ESRD are excluded. Data is then compiled to look for commonalities in their environmental exposures. The following are representative cases from our study population.
A 54 y/o M from Guatemala, who spent 30 years working as a banana farmer, developed ESRD at the age of 48. He reports chemical exposures, NSAID use, drinking home-brewed liquor, and several incidences of heat stress. His water source was unfiltered irrigation tubes in the fields. He rarely washed his hands prior to eating. His father, who was also a banana farmer, died from renal failure at the age of 80.
A 37 y/o M from El Salvador, who spent 13 years working in sugar cane and cotton fields, developed ESRD at the age of 34. He reports chemical exposures, NSAID use, and dehydration. His water was unfiltered from a spigot at home. His father and uncle, both of whom worked cutting sugar cane, died from renal failure, both at the age of 56.
A 53 y/o M from Mexico, who spent 25 years working in fields growing corn, tomatoes, and bananas, developed ESRD at the age of 40. He reports chemical exposures, NSAID use, local herbal use, and several incidence of heat stress.
Conclusion
Unfortunately there is no known treatment for Mesoamerican Nephropathy. The suspected pathogenesis of ESRD is progressive damage from repeated episodes of acute kidney injury. It is our hope that our work will contribute to the body of evidence that elucidates definitive risk factors for Mesoamerican Nephropathy. Intervention strategies directed at environmental and occupational exposures can then be implemented in efforts to prevent this malady, which is demonstrating increasing prevalence, morbidity, and mortality.