Related Experiment Video
Updated: Feb 26, 2026
5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
Published on: July 3, 2013
Clinical Evidence of Acute Mesoamerican Nephropathy
Rebecca S B Fischer1, Sreedhar Mandayam2, Denis Chavarria3
1Section of Tropical Medicine, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Abstract:
Mesoamerican nephropathy (MeN), an epidemic of unexplained kidney disease in Central America, affects mostly young, healthy individuals. Its etiology is a mystery that requires urgent investigation. Largely described as a chronic kidney disease (CKD), no acute clinical scenario has been characterized. An understanding of the early disease process could elucidate an etiology and guide treatment and prevention efforts. We sought to document the earliest clinical signs in patients with suspected MeN in a high-risk population in Nicaragua. Physicians at a local hospital identified suspect cases and documented clinical/laboratory data, demographics, and medical histories. Over a 1-year period, physicians identified 255 mostly young (median 29 years), male (89.5%) patients with elevated creatinine or reduced creatinine clearance. Mean serum creatinine (2.0 ± 0.6 mg/dL) revealed a 2-fold increase from baseline, and half had stage 2 or 3 acute kidney injury. Leukocyturia (98.4%), leukocytosis (81.4%), and neutrophilia (86.2%) predominated. Nausea (59.4%), back pain (57.9%), fever (54.6%), vomiting (50.4%), headache (47.3%), and muscle weakness (45.0%) were common. A typical case of acute MeN presented with elevated (or increased ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline) creatinine, no hypertension or diabetes, leukocyturia, and at least two of fever, nausea or vomiting, back pain, muscle weakness, headache, or leukocytosis and/or neutrophilia. Rapid progression (median 90 days) to CKD was recorded in 8.5% of patients. This evidence can serve as the basis of a sensitive and urgently needed case definition for disease surveillance of early-stage, acute MeN.
Insights
Mesoamerican nephropathy (MeN) is an epidemic kidney disease. This study identifies early acute symptoms in Nicaragua, including elevated creatinine and common signs like nausea and fever, aiding disease surveillance.
Area of Science:
- Nephrology
- Epidemiology
- Public Health
Background:
- Mesoamerican nephropathy (MeN) is an epidemic of unexplained kidney disease affecting young, healthy individuals in Central America.
- The etiology of MeN remains largely unknown, hindering effective treatment and prevention strategies.
- Existing descriptions focus on chronic kidney disease (CKD), with limited characterization of the acute clinical presentation.
Purpose of the Study:
- To document the earliest clinical and laboratory signs of acute Mesoamerican nephropathy (MeN) in a high-risk population.
- To establish a basis for a sensitive case definition for early-stage MeN surveillance.
- To understand the initial disease process to guide etiological investigation and clinical management.
Main Methods:
- Physicians in Nicaragua identified patients with suspected MeN based on clinical and laboratory data.
- Demographic information, medical histories, and laboratory results were collected over a one-year period.
- A typical case definition for acute MeN was developed based on presenting signs and symptoms.
Main Results:
- 255 patients, predominantly young males (median age 29, 89.5% male), presented with elevated creatinine or reduced creatinine clearance.
- Half of the patients exhibited stage 2 or 3 acute kidney injury, with a mean serum creatinine of 2.0 ± 0.6 mg/dL.
- Common symptoms included leukocyturia (98.4%), leukocytosis (81.4%), neutrophilia (86.2%), nausea (59.4%), back pain (57.9%), and fever (54.6%).
Conclusions:
- A typical acute MeN case involves elevated creatinine, absence of hypertension/diabetes, leukocyturia, and at least two other symptoms (fever, nausea, vomiting, back pain, weakness, headache, leukocytosis/neutrophilia).
- Rapid progression to CKD occurred in 8.5% of patients within a median of 90 days.
- The identified clinical features provide a foundation for a crucial case definition for surveillance of early-stage, acute MeN.
More Related Videos
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:29Acute Kidney Injury III: Clinical Manifestations
01:24Nephrotic Syndrome I : Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury II: Pathophysiology
01:26Nephrotic Syndrome II : Assessment and Medical Management