Mesoamerican Nephropathy (MeN): What We Know so Far

Area of Science:

• Nephrology
• Environmental Health
• Epidemiology

Background:

• Mesoamerican endemic nephropathy (MeN) is a chronic kidney disease (CKD) of unknown etiology affecting young males in coastal Central America and Mexico.
• Characterized by low eGFR, high creatinine, low albuminuria, hypokalemia, hyperuricemia, and urine urate crystals, MeN presents a diagnostic challenge.
• While thermal stress and environmental pollutants are implicated, a third factor (genetic/epigenetic) possibly interacts with social determinants.

Purpose of the Study:

• To provide an overview of Mesoamerican endemic nephropathy (MeN) based on clinical experience.
• To highlight research gaps and priorities for understanding MeN etiology, diagnosis, and management.
• To emphasize the need for clinical trials and genetic studies.

Main Methods:

• Review of clinical presentations and proposed etiological factors for MeN.
• Discussion of diagnostic challenges, including the limitations of kidney biopsy.
• Synthesis of current understanding and identification of research priorities.

Main Results:

• MeN is a distinct clinical entity predominantly affecting young males in specific geographic regions.
• Tubulointerstitial nephritis is the hallmark on biopsy, but diagnosis is often clinical.
• Etiology is likely multifactorial, involving environmental exposures, dehydration, and potentially genetic predispositions.

Conclusions:

• Further etiological and genetic research is crucial for understanding MeN.
• Clinical trials are needed to evaluate treatment efficacy and safety.
• Development of kidney disease data systems is essential for MeN research and management.