Division of Renal Medicine, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Research Center on Health, Work and Environment, National Autonomous University of Nicaragua at León, León, Nicaragua; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Am J Kidney Dis. 2017 May;69(5):626-636. doi: 10.1053/j.ajkd.2016.10.036. Epub 2017 Jan 23.
Mesoamerican nephropathy (MeN) is a chronic kidney disease affecting rural inhabitants in Central America. We have previously described the renal morphology in 8 patients from El Salvador. To confirm the renal pathology, we have studied kidney biopsies from patients with MeN in Nicaragua. Follow-up urine and blood samples from both biopsy studies were collected to investigate the natural history.
Case series.
SETTINGS & PARTICIPANTS: In the kidney biopsy study, 19 male sugarcane workers in Nicaragua with suspected MeN were investigated with questionnaires, kidney biopsies, and blood and urine analysis. Inclusion criteria were age 20 to 65 years and plasma creatinine level of 1.13 to 2.49mg/dL or estimated glomerular filtration rate (eGFR) of 30 to 80mL/min/1.73m. Exclusion criteria were proteinuria with protein excretion > 3g/24 h, uncontrolled hypertension, diabetes mellitus, or other known kidney disease. In the follow up-study, blood and urine from the kidney biopsy study in Nicaragua (n=18) and our previous biopsy study of MeN cases in El Salvador (n=7) were collected 1 to 1.5 and 2 to 2.5 years after biopsy, respectively.
Renal morphology, clinical, and biochemical characteristics, change in eGFR per year.
eGFR was calculated using the CKD-EPI creatinine (eGFR), cystatin C (eGFR), and creatinine-cystatin C (eGFR) equations.
In the kidney biopsy study, participants had a mean eGFR of 57 (range, 33-96) mL/min/1.73m. 47% had low plasma sodium and 21% had low plasma potassium levels. 16 kidney biopsies were representative and showed glomerulosclerosis (mean, 38%), glomerular hypertrophy, and signs of chronic glomerular ischemia. Mild to moderate tubulointerstitial damage and mostly mild vascular changes were seen. In the follow up-study, median duration of follow-up was 13 (range, 13-27) months. Mean change in eGFR was -4.4±8.4 (range, -27.7 to 10.2) mL/min/1.73m per year. Most patients had stopped working with sugarcane cultivation.
3 biopsy specimens had 4 or fewer glomeruli.
This study confirms the renal morphology of MeN: chronic glomerular and tubulointerstitial damage with glomerulosclerosis and chronic glomerular ischemia. Follow-up data show that eGFRs, on average, deteriorated.
中美洲肾病（MeN）是一种影响中美洲农村居民的慢性肾病。我们之前描述了来自萨尔瓦多的 8 名患者的肾脏形态。为了确认肾脏病理学，我们研究了尼加拉瓜 MeN 患者的肾脏活检。从这两项活检研究中收集了随访的尿液和血液样本，以研究其自然病史。
病例系列。
在肾脏活检研究中，对 19 名患有疑似 MeN 的尼加拉瓜甘蔗工人进行了问卷调查、肾脏活检以及血液和尿液分析。纳入标准为年龄 20 至 65 岁，血浆肌酐水平为 1.13 至 2.49mg/dL 或估算肾小球滤过率（eGFR）为 30 至 80mL/min/1.73m。排除标准为蛋白尿，蛋白尿排泄量>3g/24h，未控制的高血压，糖尿病或其他已知的肾脏疾病。在随访研究中，收集了来自尼加拉瓜肾脏活检研究（n=18）和我们之前在萨尔瓦多进行的 MeN 病例活检研究（n=7）的血液和尿液，分别在活检后 1 至 1.5 年和 2 至 2.5 年进行了随访。
肾脏形态，临床和生化特征，eGFR 每年的变化。
使用 CKD-EPI 肌酐（eGFR），胱抑素 C（eGFR）和肌酐-胱抑素 C（eGFR）方程计算 eGFR。
在肾脏活检研究中，参与者的平均 eGFR 为 57（范围，33-96）mL/min/1.73m。47％的患者血浆钠水平较低，21％的患者血浆钾水平较低。16 例肾脏活检标本具有代表性，显示出肾小球硬化（平均 38％），肾小球肥大和慢性肾小球缺血的迹象。轻度至中度肾小管间质损伤，主要为轻度血管变化。在随访研究中，中位随访时间为 13（范围，13-27）个月。eGFR 的平均变化为-4.4±8.4（范围，-27.7 至 10.2）mL/min/1.73m/年。大多数患者已经停止了甘蔗种植的工作。
3 例活检标本有 4 个或更少的肾小球。
这项研究证实了 MeN 的肾脏形态：伴有肾小球硬化和慢性肾小球缺血的慢性肾小球和肾小管间质损伤。随访数据显示，eGFR 平均恶化。
