Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? Commentary.

Abstract

The environmental nephrotoxin component as the etiology for CKD of unknown cause (CKDu) has been elegantly discussed in a debate by De Broe (pro) (1) and Wesseling (con) (2) in this issue of Kidney360 . The etiology of CKDu has been a topic of enormous controversy, and it seems that this same controversy has characterized this disease. Although it is currently unclear whether there is a unified underlying cause, these conditions have been collectively termed CKDu, but various names have emerged. They include the following: CKD of nontraditional cause, Mesoamerican nephropathy, chronic interstitial nephritis in agricultural communities, and kidney disease of unknown cause in agricultural laborers. I will refer to CKDu in my piece as it is a preferred and neutral term. It is evident that simple things, such as naming the disease or establishing a definition for CKDu, have generated enormous difficulties that create obstacles to the detection and optimal treatment. I would argue, however, that we do have consensus in some CKDu areas. First, we agree that those affected by CKDu do not have traditional risk factors or underlying conditions that lead to CKD, such as older age, diabetes mellitus, hypertension, GN, or structural kidney disease. …