Pathophysiologic insight into MesoAmerican nephropathy

Area of Science:

• Nephrology
• Environmental Health
• Occupational Medicine

Background:

• Mesoamerican nephropathy (MeN) is an emerging cause of chronic kidney disease (CKD) in Central America, primarily affecting sugarcane workers.
• Unlike traditional CKD, MeN is not associated with diabetes or hypertension, presenting a unique etiological challenge.
• Thousands of deaths in the region underscore the severity and public health impact of this condition.

Purpose of the Study:

• This review aims to elucidate the risk factors and probable mechanisms underlying the initiation and progression of Mesoamerican nephropathy.
• To provide a comprehensive overview of the current understanding of MeN pathogenesis.
• To identify potential targets for intervention and prevention strategies.

Main Methods:

• Literature review of studies investigating Mesoamerican nephropathy.
• Analysis of pathophysiological pathways implicated in CKD development.
• Synthesis of evidence linking environmental and occupational exposures to kidney injury.

Main Results:

• Recurrent subclinical acute kidney injury, driven by heat stress, dehydration, and strenuous labor, is identified as a primary risk factor for MeN.
• Chronic activation of the vasopressin, renin-angiotensin-aldosterone system, and polyol-fructokinase pathway in the kidneys is implicated.
• Subclinical rhabdomyolysis, nephrotoxin exposure, high fructose intake, and NSAID use may exacerbate disease progression.

Conclusions:

• Evidence strongly suggests that repeated cycles of heat stress, dehydration, and strenuous work contribute to CKD development.
• The chronic activation of these pathways may explain the ineffectiveness of current CKD management strategies in halting disease progression.
• Understanding these non-traditional risk factors is critical for developing effective treatments and preventive measures for MeN.