Zatz Roberto, Romão J E, Noronha I L
Renal Division, Department of Clinical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Kidney Int Suppl. 2003 Feb(83):S131-4. doi: 10.1046/j.1523-1755.63.s83.28.x.
Latin America constitutes a complex universe that shows extreme variation regarding socioeconomic and human development. Brazil is the largest and most populous Latin American country, and combines characteristics encountered in developed countries with problems typically associated with the poorest regions of the world. These disparities condition the profile of renal disease in Brazil, with glomerulonephritis still the leading cause of ESRD. Little is known about the epidemiology of renal disease in the Brazilian (or Latin American) native population, which is numerous in some Central and South American countries, but constitute a very small minority in Brazil. However, interesting information has been obtained from the Yanomamis, a tribe living in Northern Brazil and Southern Venezuela. Hypertension is virtually absent among these people, who ingest very little sodium, lending strong support to the concept that sodium retention, a "civilization" factor, plays a role in the pathogenesis of arterial hypertension. Despite Brazil's striking socioeconomic disparities, access to RRT is in principle accessible to all those in need of it. The dialysis units have been modernized in recent years, whereas the Government covers most expenses related to RRT. However, the prevalence of RRT in Brazil is currently approximately 320 per million population, less than one third as high as in the US, suggesting that ESRD may be underdiagnosed in the country. Much effort is still needed to limit the prevalence of renal disease and to improve the quality and the reach of RRT in Brazil and in Latin America.
拉丁美洲是一个复杂的整体，在社会经济和人类发展方面呈现出极大的差异。巴西是拉丁美洲最大且人口最多的国家，兼具发达国家的特征以及通常与世界最贫困地区相关联的问题。这些差异决定了巴西肾脏疾病的概况，肾小球肾炎仍是终末期肾病的主要病因。对于巴西（或拉丁美洲）原住民群体中的肾脏疾病流行病学情况，人们了解甚少，尽管在一些中美洲和南美洲国家原住民数量众多，但在巴西他们只占极少数。然而，从居住在巴西北部和委内瑞拉南部的亚诺马米部落那里，我们获得了一些有趣的信息。这些人几乎没有高血压，他们摄入的钠极少，这有力地支持了这样一种观点，即钠潴留这一“文明”因素在动脉高血压的发病机制中起作用。尽管巴西存在显著的社会经济差异，但原则上所有有需求的人都能获得肾脏替代治疗。近年来透析单位已经实现了现代化，而且政府承担了与肾脏替代治疗相关的大部分费用。然而，巴西目前肾脏替代治疗的患病率约为每百万人口320例，不到美国的三分之一，这表明该国终末期肾病可能存在诊断不足的情况。在巴西和拉丁美洲，仍需要付出很多努力来限制肾脏疾病的患病率，并提高肾脏替代治疗的质量和可及性。
