Raines Nathan, González Marvin, Wyatt Christina, Kurzrok Mark, Pool Christopher, Lemma Tiziana, Weiss Ilana, Marín Carlos, Prado Valerio, Marcas Eugenia, Mayorga Karina, Morales Jean Franco, Aragón Aurora, Sheffield Perry
Icahn School of Medicine at Mount Sinai, New York, USA.
MEDICC Rev. 2014 Apr;16(2):16-22. doi: 10.37757/MR2014.V16.N2.4.
Mesoamerican nephropathy, also known as chronic kidney disease of unknown etiology, is widespread in Pacific coastal Central America. The cause of the epidemic is unknown, but the disease may be linked to multiple factors, including diet as well as environmental and occupational exposures. As many as 50% of men in some communities have Mesoamerican nephropathy.
Describe prevalence of reduced glomerular filtration rate in a region of Nicaragua suspected to harbor high rates of Mesoamerican nephropathy; and investigate potential risk factors for such reduction associated with agricultural work (such as pesticide exposure and specific agricultural tasks associated with increased heat stress); sugar consumption; and traditional factors such as age, sex, diabetes, hypertension and nephrotoxic medication use.
This study uses a cross-sectional design with nested case-control analysis. Cases were individuals with estimated glomerular filtration rates of <60mL/min/1.73m2 and controls were individuals with those >90mL/min/1.73m2, estimated using serum creatinine. Data on nutrition, past medical history, medication and substance use, and agricultural behaviors and exposures were collected using medical questionnaires from June through August, 2012. Venous blood and urine samples were collected to assess hemoglobin A1c, and dipstick proteinuria, respectively; anthropometry and blood pressure measurements were made using standard techniques. Analyses were conducted using chi square, and univariate and multiple logistic regression.
Of 424 individuals in the study, 151 had an occupational history in agriculture. Prevalence of glomerular filtration rate <60mL/min/1.73m2 was 9.8% among women and 41.9% among men (male to female ratio = 4.3, p<0.0001). Proteinuria =300 mg/dL was observed in <10% of participants with decreased glomerular filtration rate. Hemoglobin A1c and use of NSAIDs were not associated with decreased glomerular filtration rate. Although systolic and diastolic blood pressure was higher among participants with decreased glomerular filtration rate (p <0.001), hypertension was uncommon. Significant agricultural risk factors for reduced glomerular filtration rate included increased lifetime days cutting sugarcane during the dry season (OR 5.86, 95% CI 2.45-14.01), nondeliberate pesticide inhalation (OR 3.31, 95% CI 1.32-8.31), and sugarcane chewing (OR 3.24, 95% CI 1.39-7.58).
Our findings demonstrate a high prevalence of chronic kidney disease not linked to traditional risk factors, and suggest it may be associated instead with occupational exposure to heat stress in conjunction with pesticide inhalation, sugarcane chewing and sugar intake during the workday.
中美洲肾病，也称为病因不明的慢性肾病，在中美洲太平洋沿岸地区广泛存在。该流行病的病因尚不清楚，但这种疾病可能与多种因素有关，包括饮食以及环境和职业暴露。在一些社区中，多达50%的男性患有中美洲肾病。
描述尼加拉瓜一个疑似中美洲肾病高发地区肾小球滤过率降低的患病率；调查与农业工作相关的肾小球滤过率降低的潜在风险因素（如农药暴露和与热应激增加相关的特定农业任务）；糖的摄入量；以及年龄、性别、糖尿病、高血压和肾毒性药物使用等传统因素。
本研究采用横断面设计并进行巢式病例对照分析。病例为估计肾小球滤过率<60mL/分钟/1.73平方米的个体，对照为估计肾小球滤过率>90mL/分钟/1.73平方米的个体，使用血清肌酐进行估计。2012年6月至8月期间，通过医疗问卷收集了营养、既往病史、药物和物质使用以及农业行为和暴露的数据。分别采集静脉血和尿液样本以评估糖化血红蛋白和试纸法蛋白尿；使用标准技术进行人体测量和血压测量。使用卡方检验、单因素和多因素逻辑回归进行分析。
在研究的424名个体中，151人有农业职业史。女性肾小球滤过率<60mL/分钟/1.73平方米的患病率为9.8%，男性为41.9%（男女比例=4.3，p<0.0001）。在肾小球滤过率降低的参与者中，蛋白尿≥300mg/dL的情况在不到10%的参与者中观察到。糖化血红蛋白和非甾体抗炎药的使用与肾小球滤过率降低无关。虽然肾小球滤过率降低的参与者的收缩压和舒张压较高（p<0.001），但高血压并不常见。肾小球滤过率降低的重要农业风险因素包括旱季砍伐甘蔗的终生天数增加（比值比5.86，95%置信区间2.45-14.01）、非故意吸入农药（比值比3.31，95%置信区间1.32-8.31）和嚼甘蔗（比值比3.24，95%置信区间1.39-7.58）。
我们的研究结果表明，与传统风险因素无关的慢性肾病患病率很高，并表明它可能反而与工作日期间职业性热应激暴露以及农药吸入、嚼甘蔗和糖摄入有关。
