Villalvazo Priscila, Carriazo Sol, Martin-Cleary Catalina, Sanchez-Niño Maria Dolores, Ortiz Alberto
IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain.
Clin Kidney J. 2022 Feb 10;15(7):1226-1230. doi: 10.1093/ckj/sfac042. eCollection 2022 Jul.
Aguascalientes, Mexico, has a high incidence and prevalence of advanced chronic kidney disease (CKD). CKD is especially frequent in young people ages 20-40 years in whom the cause of CKD was unknown, although kidney biopsies frequently showed focal segmental glomerulosclerosis (FSGS) and glomerulomegaly. Macias-Diaz . have now pursued this lead by screening teenagers in Calvillo, one of the hardest hit municipalities. They uncovered clinical, laboratory, kidney biopsy and exposure findings that define a new entity, Aguascalientes nephropathy, and are consistent with familial exposure to common environmental toxins, potentially consisting of pesticides. They hypothesize that prenatal exposure to these toxins may decrease nephron number. The young age of persons with FSGS would be consistent with a novel environmental toxin introduced more than 50 years ago but not present in the environment before. Key takeaways from this research are the need to screen teenagers for albuminuria, to provide kidney-protective strategies to patients identified as having CKD and for the research community to support Aguascalientes nephrologists and health authorities to unravel the cause and potential solutions for this CKD hotspot. In this regard, the screening approach and the cohort generated by Macias-Diaz . represent a giant step forward. The next steps should be to screen younger children for albuminuria and kidney size and to identify the putative toxins.
墨西哥阿瓜斯卡连特斯州晚期慢性肾脏病（CKD）的发病率和患病率很高。CKD在20至40岁的年轻人中尤为常见，这些人的CKD病因不明，尽管肾活检经常显示局灶节段性肾小球硬化（FSGS）和肾小球肿大。马西亚斯 - 迪亚兹等人现在通过对受灾最严重的城市之一卡尔维洛的青少年进行筛查来继续这一研究。他们发现了一些临床、实验室、肾活检和暴露方面的结果，这些结果定义了一种新的病症——阿瓜斯卡连特斯肾病，并且与家族性接触常见环境毒素（可能包括农药）相符。他们推测，产前接触这些毒素可能会减少肾单位数量。FSGS患者的年轻年龄与50多年前引入但之前不存在于环境中的新型环境毒素相符。这项研究的关键要点是需要对青少年进行蛋白尿筛查，为被确定患有CKD的患者提供肾脏保护策略，以及研究界支持阿瓜斯卡连特斯的肾病学家和卫生当局来查明这一CKD热点地区的病因和潜在解决方案。在这方面，马西亚斯 - 迪亚兹等人采用的筛查方法和建立的队列代表了向前迈出的一大步。接下来的步骤应该是对年幼儿童进行蛋白尿和肾脏大小筛查，并确定推定的毒素。
