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Epidemic renal disease of unknown etiology in the Zuni Indians
Abstract:
An epidemic of renal disease is occurring among the Zuni Indians in western New Mexico. In 1985, 1.6% of Zunis had clinically recognized renal disease and 1% had renal insufficiency. The incidence of end-stage renal disease (ESRD) in 1984 and 1985 was 14 times the rate for US whites, and three times the rates of other Indians in ESRD network 6. One third of the cases of renal disease and ESRD is due to type 2 diabetes, but the etiology of disease in most of the remainder is unknown. Affected subjects range from early childhood to old age. Early signs are hematuria, mild to moderate proteinuria, normal BP, and low total hemolytic complement, normal or low C3 and C4 levels, in about 40% of the cases. The clinical course varies from benign to rapidly progressive renal failure. Biopsies usually reflect an immune-complex mediated mesangiopathic glomerulonephritis, with IgA, IgG, IgM, and C3 variably present in the mesangium. In some cases, there is a very strong familial pattern suggesting autosomal dominant inheritance or a marked communal exposure effect. This may be a genetic disease educed by the consanguinity in the ethnically homogeneous Zuni population. Mesangiopathic renal disease is common in some Oriental populations, and this phenomenon may reflect the American Indians' Oriental ancestry. This disease may also be due to toxic exposures related to jewelry-making, potting, Zuni water, Zuni salt, or herbal or other products used for medicinal or religious purposes. This epidemic is much morbidity and generating huge costs for ESRD treatment. Further study is needed to better understand its etiology.
Insights
An epidemic of kidney disease affects Zuni Indians, with high rates of end-stage renal disease (ESRD). While type 2 diabetes is a factor, the cause for most cases remains unknown, necessitating further research.
Area of Science:
- Nephrology
- Epidemiology
- Genetics
Background:
- An unusual epidemic of renal disease is prevalent among the Zuni Indian population in New Mexico.
- Rates of clinically recognized renal disease, renal insufficiency, and end-stage renal disease (ESRD) are significantly elevated compared to US whites and other Native American groups.
Purpose of the Study:
- To investigate the prevalence, characteristics, and potential etiologies of the renal disease epidemic in the Zuni population.
Main Methods:
- Epidemiological data collection on renal disease and ESRD incidence.
- Clinical examination and laboratory testing (including complement levels) for affected individuals.
- Renal biopsy analysis to determine pathological characteristics.
- Assessment of potential genetic and environmental factors.
Main Results:
- In 1985, 1.6% of Zunis had diagnosed renal disease and 1% had renal insufficiency.
- ESRD incidence was 14 times higher than US whites and three times higher than other Native Americans in ESRD network 6.
- Type 2 diabetes accounted for one-third of renal disease and ESRD cases; etiology for the remainder is unknown.
- Early signs include hematuria, proteinuria, normal blood pressure, and altered complement levels in 40% of cases.
- Renal biopsies often show immune-complex mediated mesangiopathic glomerulonephritis.
- A familial pattern suggests possible genetic factors, potentially linked to consanguinity or ancestral origins.
- Environmental exposures (e.g., toxins from crafts, local resources) are also being considered.
Conclusions:
- The Zuni population experiences a significant epidemic of renal disease with unknown etiology in many cases.
- Potential contributing factors include type 2 diabetes, genetic predispositions, and environmental exposures.
- Further research is crucial to elucidate the specific causes and develop targeted interventions for this health crisis.