Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica.
Program on Work, Environment and Health in Central America (SALTRA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica.
Am J Kidney Dis. 2014 Mar;63(3):396-404. doi: 10.1053/j.ajkd.2013.08.014. Epub 2013 Oct 17.
The First International Research Workshop on Mesoamerican Nephropathy (MeN) met in Costa Rica in November 2012 to discuss how to establish the extent and degree of MeN, examine relevant causal hypotheses, and focus efforts to control or eliminate the disease burden. MeN describes a devastating epidemic of chronic kidney disease of unknown origin predominantly observed among young male sugarcane cutters. The cause of MeN remains uncertain; however, the strongest hypothesis pursued to date is repeated episodes of occupational heat stress and water and solute loss, probably in combination with other potential risk factor(s), such as nonsteroidal anti-inflammatory drug and other nephrotoxic medication use, inorganic arsenic, leptospirosis, or pesticides. At the research workshop, clinical and epidemiologic case definitions were proposed in order to facilitate both public health and research efforts. Recommendations emanating from the workshop included measuring workload, heat, and water and solute loss among workers; quantifying nephrotoxic agents in drinking water and food; using biomarkers of early kidney injury to explore potential causes of MeN; and characterizing social and working conditions together with methods for valid data collection of exposures and personal risk factors. Advantages and disadvantages of different population study designs were detailed. To elucidate the etiology of MeN, multicountry studies with prospective cohort design, preferably integrating an ecosystem health approach, were considered the most promising. In addition, genetic, experimental, and mechanistic methods and designs were addressed, specifically the need for kidney biopsy analysis, studies in animal models, advances in biomarkers, genetic and epigenetic studies, a common registry and repository of biological and demographic data and/or specimens, and other areas of potential chronic kidney disease experimental research. Finally, in order to improve international collaboration on MeN, workshop participants agreed to establish a research consortium to link these Mesoamerican efforts to other efforts worldwide.
第一届中美洲肾病（MeN）国际研究研讨会于 2012 年 11 月在哥斯达黎加举行，旨在讨论如何确定 MeN 的范围和程度，检验相关因果假说，并集中精力控制或消除疾病负担。MeN 描述了一种破坏性的慢性肾病流行，病因不明，主要发生在年轻男性甘蔗收割工人中。MeN 的病因仍不确定；然而，迄今为止，研究最多的假说与反复发生的职业性热应激和水及溶质丢失有关，可能与其他潜在的危险因素（如非甾体抗炎药和其他肾毒性药物、无机砷、钩端螺旋体病或杀虫剂）有关。在研究研讨会上，提出了临床和流行病学病例定义，以便于公共卫生和研究工作。研讨会提出的建议包括测量工人的工作量、热和水及溶质丢失；量化饮用水和食物中的肾毒性物质；使用早期肾损伤生物标志物来探索 MeN 的潜在原因；以及描述社会和工作条件以及暴露和个人危险因素的有效数据收集方法。详细讨论了不同人群研究设计的优缺点。为了阐明 MeN 的病因，多国家前瞻性队列设计的研究被认为是最有前途的研究方法，最好整合生态系统健康方法。此外，还讨论了遗传、实验和机制方法和设计，特别是需要进行肾活检分析、动物模型研究、生物标志物的进展、遗传和表观遗传研究、生物和人口数据和/或标本的共同登记处和储存库，以及其他潜在的慢性肾病实验研究领域。最后，为了改善 MeN 的国际合作，研讨会参与者同意建立一个研究联盟，将这些中美洲的努力与全球其他努力联系起来。
