Abstract: FR-PO0286
From Heat to Cold: A Case of Mesoamerican Nephropathy
Session Information
- CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Lu, Yuchen, University of Rochester Medical Center, Rochester, New York, United States
- Rutowski, James Jude, University of Rochester Medical Center, Rochester, New York, United States
- Sabescumar, Janany Jansy, University of Rochester Medical Center, Rochester, New York, United States
Introduction
Chronic kidney disease of untraditional etiology (CKDnt), or Mesoamerican nephropathy (MeN), is a type of interstitial nephritis primarily affecting individuals in Central America and Sri Lanka. This diagnosis of exclusion primarily affects asymptomatic men aged 20 to 50 years engaged in labor-intensive work. Patients often present late with advanced kidney dysfunction and severe metabolic complications. Risk factors include heat stress, dehydration, and NSAID use. We report a young Guatemalan immigrant laborer in Upstate New York presenting with severe renal failure concerning for end-stage renal disease (ESRD) likely secondary to CKDnt.
Case Description
A reportedly healthy 25-year-old man immigrated to Upstate New York from Guatemala. Two months prior to his presentation, he developed frothy urine followed by one month of abdominal pain and unintentional weight loss. He worked in manual labor and reported daily acetaminophen (1000 mg) and naproxen (440 mg) use for 5 years. He also reported low birth weight.
On presentation, he reported diffuse abdominal pain and nausea without edema, chest pain, gross hematuria, or reduced urine output. Laboratory studies showed creatinine 25 mg/dL, blood urea nitrogen 137 mg/dL, calcium 6 mg/dL, phosphorus 9.7 mg/dL, anion gap metabolic acidosis, and urine protein-to-creatinine ratio 11.46. CT scan revealed bilateral atrophic kidneys without hydronephrosis. A secondary workup for nephrolitic range proteinuria, including ANA, dsDNA, ANCA, anti-GBM, PLA2R, cryoglobulins, and complement studies, was negative. Kidney biopsy was deferred due to advanced disease and atrophic kidneys on imaging. He was started on hemodialysis for acute renal failure with uremia and electrolyte abnormalities.
Discussion
CKDnt most commonly affects young male laborers from Central America and is associated with chronic heat stress, dehydration, and NSAID exposure. Our patient had several characteristic risk factors, including Guatemalan origin, manual labor exposure, chronic NSAID use, and low birth weight. His unrevealing extensive serologic evaluation supported a nonimmune etiology.
This case highlights the importance of recognizing CKDnt/MeN in immigrants from endemic regions presenting in nontraditional geographic areas with unexplained advanced renal failure. Clinicians outside historically affected regions should maintain awareness of CKDnt/MeN, particularly in young laborers without traditional CKD risk factors.
Acknowledgment
The author would like to acknowledge Dr. Claire Filloux and Dr. Alon Bazelol for their help and valuable input in this case report.