Macias Diaz Dulce M, Corrales Aguirre Myriam Del Carmen, Reza Escalera Ana Lilian, Tiscareño Gutiérrez Maria Teresa, Ovalle Robles Itzel, Macías Guzmán Mariana Jocelyn, García Díaz Andrea L, Gutiérrez Peña Mauricio C, Alvarado-Nájera Andrea Natalia, González Domínguez Israel, Villavicencio-Bautista Juan Carlos, Herrera Rodríguez Angela Azucena, Marín-García Ricardo, Avelar González Francisco Javier, Wong Alfredo Chew, Galván Guerra Elba, Delgadillo Castañeda Rodolfo, Prado Aguilar Carlos Alberto, Zúñiga-Macías Leslie P, Arreola Guerra José Manuel
Department of Pathology, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico.
Department of Nephrology, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico.
Clin Kidney J. 2022 Jan 14;15(7):1300-1311. doi: 10.1093/ckj/sfac018. eCollection 2022 Jul.
End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes, Mexico, is one of the highest worldwide, particularly in adults between 20 and 40 years of age. Our aim was to screen adolescents for chronic kidney disease (CKD) to identify risk factors and histologically characterize adolescents with persistent albuminuria.
This was a cross-sectional, observational and comparative study of adolescents in whom serum creatinine and the albumin:creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥30 mg/g) or a low glomerular filtration rate (GFR) (≤75 mL/min/1.73 m) were re-evaluated and a renal ultrasound (US) was obtained. A kidney biopsy was performed in patients with persistent albuminuria.
A total of 513 students were included; 19 had persistent albuminuria and 494 were controls. The prevalence of persistent albuminuria was 3.7% [95% confidence interval (CI) 2.1-5.3]. Only one patient had a decreased GFR. None of the patients with persistent albuminuria had anatomical abnormalities of the urinary tract by renal US. Patients with persistent albuminuria had a decreased total renal volume compared with the control group (150 versus 195 mL/m; P < 0.01). Eighteen kidney biopsies were performed; 72% had glomerulomegaly and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy, including partial fusion (100%), microvillous degeneration (80%) and increased organelles (60%). Risk factors for persistent albuminuria were: homestead proximity to maize crops, the use of pesticides at the father's workplace, a family history of CKD and blood pressure abnormalities. The body mass index and breastfeeding were protective factors.
The prevalence of persistent albuminuria in adolescents in Aguascalientes is high and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of persistent albuminuria patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in this setting.
不明原因的终末期肾衰竭（ESRD-UO）是墨西哥及世界许多地区的一个公共卫生问题。墨西哥阿瓜斯卡连特斯市的ESRD-UO患病率是全球最高的地区之一，尤其是在20至40岁的成年人中。我们的目的是对青少年进行慢性肾脏病（CKD）筛查，以确定危险因素，并对持续性蛋白尿的青少年进行组织学特征分析。
这是一项针对青少年的横断面、观察性和对比性研究，在筛查CKD时测定血清肌酐和白蛋白：肌酐比值（ACR）。进行了临床评估和危险因素调查。对ACR异常（≥30mg/g）或肾小球滤过率（GFR）低（≤75mL/min/1.73m²）的患者进行了重新评估，并进行了肾脏超声（US）检查。对持续性蛋白尿患者进行了肾活检。
共纳入513名学生；19名有持续性蛋白尿，494名作为对照。持续性蛋白尿的患病率为3.7%[95%置信区间（CI）2.1-5.3]。只有一名患者的GFR降低。持续性蛋白尿患者中，通过肾脏超声检查均未发现尿路解剖异常。与对照组相比，持续性蛋白尿患者的总肾体积减小（150对195mL/m²；P<0.01）。进行了18例肾活检；72%有肾小球肿大，只有一名患者有轻度纤维化。电子显微镜下可见足细胞异常，包括部分融合（100%）、微绒毛变性（80%）和细胞器增多（60%）。持续性蛋白尿的危险因素有：住所靠近玉米作物、父亲工作场所使用杀虫剂、CKD家族史和血压异常。体重指数和母乳喂养是保护因素。
阿瓜斯卡连特斯市青少年持续性蛋白尿的患病率很高，组织学损害的特征是在无纤维化的情况下足细胞损伤。持续性蛋白尿患者的肾体积减小，提示肾单位减少。接触环境毒素如杀虫剂，即使是在产前，可能是导致这一病理实体的原因。在这种情况下，通过测定ACR对青少年进行筛查项目是必要的。
