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Kidney Week

Abstract: SA-PO063

Mesoamerican Nephropathy: Opening New Horizons

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Cajina Aguirre, Carmen Lorena, The University of Kansas Medical Center, Kansas City, Kansas, United States
  • Marín, Carlos Alberto, Hospital Monte España, Managua, Nicaragua
  • Strasma, Anna, Duke University, Durham, North Carolina, United States
Introduction

Mesoamerican nephropathy is a chronic kidney disease of significant importance in Central America. It mainly affects young men in the agricultural field from the Pacific Coast of Nicaragua, and a prevalence of up to 42% has been described in this population. The precise etiology of Mesoamerican Nephropathy (MeN) still remains a mystery.

Case Description

A 37-year-old male from an urban area, who works in construction, with no personal history of hypertension, diabetes, or autoimmune diseases, presents with edema and fatigue. Creatinine levels of 16.5 mg/dL and BUN of 78 mg/dL were observed. Physical examination revealed normal blood pressure and hyporeflexia. Significant laboratory findings included uric acid: 10.6, potassium:3.1 mmol/l, sodium: 134 mmol/l, urinalysis showing proteinuria lower than 0.7 g/dL, and urate crystals. Imaging findings were consistent with CKD. Considering his place of origin and occupation, which expose him to thermal stress and repetitive episodes of dehydration, and in the absence of other causes that could explain the CKD, the first differential to be considered is MeN. Histopathological studies are not feasible for diagnostic confirmation. According to case definitions, this patient can be classified as a probable case of MeN. The patient initiated renal replacement therapy with hemodialysis in a 3-session-per-week schedule, resulting in significant improvement of the clinical condition.

Discussion

The high risk of CKD in agricultural workers in warm areas of Central America has been previously described. However, a high prevalence (12.1%) has also been reported in other occupation with high temperature expose. MeN diagnosis still remains a challenge due to the lack of access to histopathological diagnosis confirmation in the healthcare system. This clinical case allows us to consider other occupation and geographical locations as possible risk factors for the occurrence of MeN. Priority and urgent actions to contain the advancement of this disease should be focused on early diagnosis and prevention in high-risk areas and occupations. It is important to expand the study of MeN to other occupations that share exposure to high temperatures. The economic and health impact of MeN should be mitigated with diagnostic and treatment strategies, as well as expanded research funding for other occupations.