Mesoamerican Nephropathy

Mesoamerican endemic nephropathy is a type of chronic kidney disease of unknown origin, present in pockets of high prevalence along the Pacific Ocean coast of the Mesoamerican region, from southwest Mexico to Costa Rica. The disease is common in young adult men, most often yet not exclusively from agricultural communities, and with a high mortality rate. Kidney biopsy specimens show primarily tubular atrophy and interstitial fibrosis with some glomerular changes attributed to ischemia. Exposure to agrochemicals, heavy metals or metalloids, intense physical activity under heat stress with dehydration, infections, among other possible causes have been hypothesized as the culprit of the disease. Hypokalemia and hyperuricemia are frequent clinical features. Early diagnosis is key to initiate timely treatment and slow down the progression to end-stage kidney disease. At present, our knowledge about the magnitude of the disease burden imposed by Mesoamerican endemic nephropathy is clearly incomplete and its cause has not been determined. There is a need to implement epidemiologic and mechanistic research projects as well as formal chronic kidney disease and end-stage kidney disease registries in the Mesoamerican region to better understand the real extent of the epidemic, delimit risk populations, and to construct sound public health policy decisions. (C) 2019 Elsevier Inc. All rights reserved.