Department of Renal Medicine, University College London, London, UK
Department of Renal Medicine, University College London, London, UK.
Occup Environ Med. 2019 Dec;76(12):920-926. doi: 10.1136/oemed-2019-105772. Epub 2019 Sep 27.
There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years.
Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined.
Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection.
The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.
中美洲的梅奥罗尼亚肾病（MeN）流行，该地区是蔗糖的主要产地。人们提出了许多病因，但迄今为止，仅有有限的证据支持任何一种假说。本研究采用生物样本，对 350 名居住在尼加拉瓜西北部、有患 MeN 风险的年轻成年人进行了一项嵌套病例对照研究，该研究是对蔗糖收获前（基线）和收获后（6 个月随访）尿液样本进行检测，旨在分析金属、农药和霉菌毒素与两年内肾功能下降之间的关系。
使用电感耦合等离子体质谱法分析了 12 种金属和类金属（铝、总砷、镉、铬、钴、铜、铅、锰、汞、硒、硅和锶）。采用液相色谱-串联质谱法分析了 12 种农药或其代谢物（2,4-二氯苯氧基乙酸、3-苯氧基苯甲酸、4-氟-3-苯氧基苯甲酸、氯-3,3,3-三氟-1-丙烯基-2,2-二甲基环丙烷羧酸、顺/反式 3-(2,2-二氯乙烯基)-2,2-二甲基环丙烷羧酸、乙撑硫脲、草甘膦、4-氯-2-甲基苯氧乙酸、3-羟基嘧啶硫醇、5-羟基噻苯达唑、羟基三唑酮和 3,5,6-三氯-2-吡啶醇）和 2 种霉菌毒素（赭曲霉毒素 A（OTA）和桔青霉素（CIT））。检测了结果组（肾功能稳定与下降的参与者）之间经肌酐校正的尿液中测量暴露物的浓度差异。
在整个人群中均检测到铝和总砷水平升高，以及几种农药的代谢物。在检测的金属或农药水平方面，在下降组和稳定组之间未发现差异。OTA 和 CIT 低于检测限。
在有患 MeN 风险的参与者中，测试的金属、类金属、农药和霉菌毒素与肾功能丧失无关。
