Abstract: SA-PO861
Urine Testing of Community Residents in a Region of Nicaragua with a High Burden of Mesoamerican Nephropathy Reveals That Background Systemic Inflammatory Signs Rapidly Increase in Younger Ages
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Strasma, Anna, Baylor College of Medicine, Houston, Texas, United States
- Mandayam, Sreedhar A., UT MD Anderson Cancer Center, Bellaire, Texas, United States
- Vangala, Chandan, Baylor College of Medicine, Houston, Texas, United States
- Fischer, Rebecca S.b., Texas A&M Health Science Center, Houston, Texas, United States
Background
A large and ongoing epidemic of kidney disease of unknown etiology affects the rural poor from Mexico to Panama and has resulted in greater than 50,000 deaths. Mesoamerican nephropathy (MeN) is a devastating and rapidly progressing disease that affects primarily young agriculture workers who are otherwise healthy and lack traditional risk factors for kidney disease. Very little is known about renal function in the community-at-large, especially among children.
Methods
Urine specimens were collected from individuals of all ages at health fairs in 4 rural, agricultural communities in the Pacific lowland areas of Nicaragua, a region heavily affected by MeN and where morbidity and mortality due to the epidemic has more than quadrupled since its emergence. Semi-quantitative dipstick and microscopic analysis were performed on fresh specimens. We generated descriptive statistics and tested for differences by age and community by Chi-squared and ANOVA in Stata 15.
Results
Urine from 471 community residents, ages 3 months to 89 years (median 21 years) were analyzed. Almost all individuals (99%) were shedding leukocytes, many (21%) with >5 per field. Renal cell shedding (11%), hematuria (13.4%) were also noted. Proteinuria was rare (3.2%). Hematuria and leukocyturia varied by locale (p<0.05). Leukocyturia was more common in adults than children (p<0.05). Leukocyturia increased with age, which was driven by the age group 12-33 years.
Conclusion
In this community-based sample, clinical urine specimens indicate an underlying prevalence of markers of impaired renal function. These markers increase in adolescence and young adulthood. Further investigations into MeN should target populations other than agricultural workers and should specifically look at renal function in children. Geographic differences in clinical indicators may also point to the highest risk communities.