Published Papers

Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy

Investigators

Catharina Wesseling

Journal

Occupational & Environmental Medicine

Published date:

1 Dec 2019

Objectives: To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. Methods: Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), […]

Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu

Investigators

Jason Glaser

Journal

NEPHROLOGISTS SANS FRONTIÈRES

Published date:

1 Dec 2019

Twenty years ago, nephrologists working in El Salvador and Sri Lanka described a progressive kidney disease leading to devastatingly high rates of death from kidney failure in young and middle-aged individuals.1,2 Other descriptions including documentaries and press reports brought chronic kidney disease of unknown etiology (CKDu) to the world’s attention, presenting the toll on working families unable to afford kidney replacement therapy.3 Additional regions with a similar profile of kidney […]

Experimental heat stress nephropathy and liver injury are improved by allopurinol

Investigators

Richard Johnson

Journal

American Journal of Physiology-Renal Physiology

Published date:

1 Sep 2018

An epidemic of chronic kidney disease (CKD) has been observed in Central America among workers in the sugarcane fields. One hypothesis is that the CKD may be caused by recurrent heat stress and dehydration, and potentially by hyperuricemia. Accordingly, we developed a murine model of kidney injury associated with recurrent heat stress. In the current experiment, we tested whether treatment with allopurinol (a xanthine oxidase inhibitor that reduces serum urate) […]

Fructokinase activity mediates dehydration-induced renal injury

Investigators

Richard Johnson

Journal

Kidney International

Published date:

1 Aug 2014

The epidemic of chronic kidney disease in Nicaragua (Mesoamerican nephropathy) has been linked with recurrent dehydration. Here we tested whether recurrent dehydration may cause renal injury by activation of the polyol pathway, resulting in the generation of endogenous fructose in the kidney that might subsequently induce renal injury via metabolism by fructokinase. Wild-type and fructokinase-deficient mice were subjected to recurrent heat-induced dehydration. One group of each genotype was provided water […]

Heat Stress Nephropathy From Exercise-Induced Uric Acid Crystalluria: A Perspective on Mesoamerican Nephropathy

Investigators

Richard Johnson

Journal

American Journal of Kidney Diseases

Published date:

1 Jan 2016

Mesoamerican nephropathy (MeN), an epidemic in Central America, is a chronic kidney disease of unknown cause. In this article, we argue that MeN may be a uric acid disorder. Individuals at risk for developing the disease are primarily male workers exposed to heat stress and physical exertion that predisposes to recurrent water and volume depletion, often accompanied by urinary concentration and acidification. Uric acid is generated during heat stress, in […]

Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador–A cross-shift study of workers at risk of Mesoamerican nephropathy

Investigators

Jason Glaser

Journal

Environmental Research

Published date:

1 Oct 2015

Background: An epidemic of progressive kidney failure afflicts sugarcane workers in Central America. Repeated high-intensity work in hot environments is a possible cause. Objectives: To assess heat stress, dehydration, biomarkers of renal function and their possible associations. A secondary aim was to evaluate the prevalence of pre-shift renal damage and possible causal factors. Methods: Sugarcane cutters (N=189, aged 18-49 years, 168 of them male) from three regions in El Salvador […]

Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua

Investigators

Richard Johnson

Journal

BMJ Open

Published date:

8 Dec 2016

Objectives: To study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations. Design: Cross-sectional. Setting: Chinandega and León municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January-February 2013. Participants: 194 male workers aged 17-39 years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers. Outcome measures: (1) Differences between the three occupational groups in prevalences/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease […]

Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin

Investigators

David Wegman

Journal

Annals of Work Exposures and Health

Published date:

17 Feb 2024

Objectives: Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. […]

Impact of heat on emergency hospital admissions related to kidney diseases in Texas: Uncovering racial disparities

Investigators

Jason Glaser

Journal

Science of the Total Environment

Published date:

20 Jan 2024

Background and objective: While impact of heat exposure on human health is well-documented, limited research exists on its effect on kidney disease hospital admissions especially in Texas, a state with diverse demographics and a high heat-related death rate. We aimed to explore the link between high temperatures and emergency kidney disease hospital admissions across 12 Texas Metropolitan Statistical Areas (MSAs) from 2004 to 2013, considering causes, age groups, and ethnic […]

Increase of core temperature affected the progression of kidney injury by repeated heat stress exposure

Investigators

Richard Johnson

Journal

American Journal of Physiology-Renal Physiology

Published date:

1 Nov 2019

An epidemic of chronic kidney disease of unknown etiology (Mesoamerican nephropathy) has emerged in hot regions of Central America. We have demonstrated that dehydration associated with recurrent heat exposure causes chronic kidney disease in animal models. However, the independent influence of core body temperature on kidney injury has not been explored. In the present study, we tested the hypothesis that kidney injury could be accelerated by increasing body temperature independent […]

Inhaled silica nanoparticles cause chronic kidney disease in rats

Investigators

Julia Wijkström

Journal

American Journal of Physiology-Renal Physiology

Published date:

1 Jul 2022

Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats. We administered 200- or 300-nm amorphous SiNPs twice weekly (4 mg/dose), or vehicle by oropharyngeal aspiration for 13 wk to rats followed […]

International Collaboration for the Epidemiology of eGFR in Low and Middle Income Populations – Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE)

Investigators

Jason Glaser

Journal

BMC Nephrology

Published date:

3 Jan 2017

Background: There is an increasing recognition of epidemics of primarily tubular-interstitial chronic kidney disease (CKD) clustering in agricultural communities in low- and middle-income countries (LMICs). Although it is currently unclear whether there is a unified underlying aetiology, these conditions have been collectively termed CKD of undetermined cause (CKDu). CKDu is estimated to have led to the premature deaths of tens to hundreds of thousands of young men and women over […]

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