Abstract: FR-PO096

Clinical Factors Associated with Progression from Acute Mesoamerican Nephropathy to CKD

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Author

  • Fischer, Rebecca S.b., Baylor College of Medicine, Houston, Texas, United States
Background

Greater than 20,000 deaths in Central America have been attributed to the epidemic of Mesoamerican nephropathy (MeN). Men is a mysterious kidney disease of unknown etiology that disproportionately affects young agricultural workers without traditional risk factors for kidney disease. MeN had been characterized as a chronic kidney disease (CKD) until we recently documented an acute clinical scenario, characterized by acute kidney injury (AKI) with interstitial nephritis and markers of systemic inflammation, namely neutrophilic leukocytosis and leukocyturia. We also observed that some patients, but not all, later progressed to CKD.

Methods

We conducted an analysis to identify clinical characteristics of acute MeN that predict progression to CKD. Using univariate analysis, we compared patients with acute MeN who developed CKD to those who did not to identify clinical risk factors for CKD. Physicians at a private hospital in Nicaragua completed case reports detailing acute clinical encounters on cases of MeN and provided follow-up data on subsequent CKD diagnoses.

Results

From Feb 2015-Jan 2017, 468 cases of acute MeN were reported, mostly male (91%) and young (median age 27 yrs). Most (92%) had acute kidney injury (AKI). Frequent acute symptoms were fever (62%), nausea/vomiting (72%), back pain (61%), and headache (52%). Leukocytosis (80%), neutrophilia (84%), lymphopenia (53%), elevated C-reactive protein (76%), and anemia (59%) were common, along with leukocytes (99%) and leukocyte casts (30.2%) in urine. 30 patients (6%) progressed rapidly (median 90 days) to CKD, with half (51%) progressing to ≥Stage 3 CKD. We found that age >25 years (Prevalence Ratio [PR] 2.90 [1.03, 8.19], p=0.045), hyperuricemia (2.56 [1.26, 5.21], p=0.010), anemia (3.37 [1.31, 8.67], p=0.012) and hyponatremia (PR 3.20 [1.46, 7.02], p=0.004) were associated with CKD. Leukocytosis (PR 0.39 [95%CI 0.19, 0.81], p=0.012) and leukocyturia (PR 0.36 [0.17, 0.75], p=0.006) during the acute phase of MeN were negatively associated with CKD.

Conclusion

Our data suggest that acute systemic inflammation during acute MeN may mediate progression to CKD. Our ongoing longitudinal analysis will enhance our understanding of clinical events during disease progression and shed light on the mechanism of injury. This is the first of clinical factors associated with CKD and with recovery in MeN.

Funding

  • Private Foundation Support