Abstract
In recent years, Central America, Egypt, India and Sri Lanka have reported a high prevalence of chronic kidney disease of unknown etiology in agricultural communities, predominantly among male farmworkers. This essay examines the disease's case definitions, epidemiology (disease burden, demographics, associated risk factors) and causal hypotheses, by reviewing published findings from El Salvador, Nicaragua, Costa Rica, Sri Lanka, Egypt and India. The range of confirmed chronic kidney disease prevalence was 17.9%-21.1%. Prevalence of reduced glomerular filtration (<60 mL/min/1.73 m2 body surface area) based on a single serum creatinine measurement was 0%-67% men and 0%-57% women. Prevalence was generally higher in male farmworkers aged 20-50 years, and varied by community economic activity and altitude. Cause was unknown in 57.4%-66.7% of patients. The dominant histopathological diagnosis was chronic tubulointerstitial nephritis. Associations were reported with agricultural work, agrochemical exposure, dehydration, hypertension, homemade alcohol use and family history of chronic kidney disease. There is no strong evidence for a single cause, and multiple environmental, occupational and social factors are probably involved. Further etiological research is needed, plus interventions to reduce preventable risk factors.
Highlights
Históricamente, las principales causas de la enfermedad renal crónica (ERC) son la diabetes y la hipertensión, asociadas al envejecimiento y la obesidad en los países desarrollados y ahora en algunos países en vía de desarrollo
Además de estas causas “tradicionales”, las enfermedades glomerulares y tubulointersticiales debidas a infecciones, medicamentos nefrotóxicos, consumo de hierbas medicinales, toxinas ambientales y exposición ocupacional a pesticidas —las nombradas causas “no tradicionales”— contribuyen a la carga de ERC en los países en vía de desarrollo.[1,9,10]
Esta nueva enfermedad difiere en sus características epidemiológicas de la ERC tradicional —específicamente, hay un predominio en hombres jóvenes agricultores— y ha devenido un importante problema de salud
Summary
América Central, Egipto, India y Sri Lanka han reportado una alta prevalencia de enfermedad renal crónica de causa desconocida en comunidades agrícolas, predominantemente entre hombres agricultores. Este artículo examina las definiciones de caso de la enfermedad, la epidemiología (carga de enfermedad, características demográficas, factores de riesgo asociados) y las hipótesis causales, a través de la revisión de hallazgos publicados en El Salvador, Nicaragua, Costa Rica, Sri Lanka, Egipto e India. El rango de la prevalencia de enfermedad renal crónica confirmada fue del 17.9%–21.1%. La prevalencia de la filtración glomerular disminuida (
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