International Journal of Nephrology and Renovascular Disease (Oct 2020)
Mesoamerican Nephropathy (MeN): What We Know so Far
Abstract
Vicente Sanchez Polo,1 Ramon Garcia-Trabanino,2,3 Guillermo Rodriguez,4 Magdalena Madero5 1Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala; 2Centro de Hemodiálisis, San Salvador, El Salvador; 3Fondo Social de Emergencia Para la Salud, Tierra Blanca, El Salvador; 4Service of Nephrology, Hospital Dr. R.A. Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica; 5Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, México, MéxicoCorrespondence: Magdalena MaderoDivision of Nephrology, Instituto Nacional de Cardiologia Ignacio Chavez, Juan Badiano 1, Col Seccion XVI, México CP 14080, MéxicoEmail [email protected]: In 2002, a report from El Salvador described a high incidence of chronic kidney disease (CKD) of unknown cause, mostly in young males from specific coastal areas. Similar situations were observed along the Pacific Ocean coastline of other Central American countries and southern Mexico (Mesoamerica). This new form of CKD has been denominated Mesoamerican endemic nephropathy (MeN). The typical presentation of MeN is a young male from an endemic area with a family history of CKD, low eGFR, high serum creatinine, low level of albuminuria, hypokalemia, hyperuricemia, and urine urate crystals. Kidney biopsy demonstrating tubulointerstitial nephritis remains the gold standard for diagnosis but is available only for a minority. Commonly proposed causes include thermal stress/dehydration and/or exposure to environmental pollutants. However, likely, a third factor, which could be genetic or epigenetic, could contribute to the cause and development of the disease, along with social determinants. Currently, preventive measures focus on minimizing workers exposure to thermal stress/dehydration. There are many research opportunities and priorities should include clinical trials to evaluate the efficacy and safety of the current treatment protocols, along with etiological and genetic studies, and the development of kidney disease data systems. Although there is scant and controversial literature with regard s to the etiology, diagnosis and management of the disease, our aim is to provide the reader a vision of the disease based on our experience.Keywords: Mesoamerican nephropathy, MeN, heat stress, CKDu, CKDnt, endemic nephropathy, regional nephropathy
