Published Papers

Introduction: A recently recognised form of chronic kidney disease (CKD) of unknown origin (CKDu) is afflicting communities, mostly in rural areas in several regions of the world. Prevalence studies are being conducted in a number of countries, using a standardised protocol, to estimate the distribution of estimated glomerular filtration rate (eGFR), and thus identify communities with a high prevalence of reduced glomerular filtration rate (GFR). In this paper, we propose […]

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 […]

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 […]

Background: Chronic kidney disease is common among sugarcane workers in Central America. The main risk factor seems to be repeated high-intensity work in hot environments. Several cross-sectional studies have been performed but few longitudinal studies. Objectives: The aim of the study was to examine whether kidney function changes over a few months of work during the harvest period. Methods: A group of male sugarcane cutters in Nicaragua (N=29, aged 17-38 […]

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 […]

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 […]

We welcome the publication “Changes in kidney function among Nicaraguan sugarcane workers,”Citation1 which raises important issues regarding the Mesoamerican nephropathy (MeN), an epidemic of chronic kidney disease (CKD) of non-traditional etiology (CKDnT) – not explained by known risk factors. This epidemic along the Pacific coast of Mesoamerica has caused the death of many thousands of workers over decades in multiple countries, but only recently has it become known in the […]

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 […]