I just read this new about what they call "the sugar cane disease" in Nicaragua and the rest of the countries in Central America, and realize that in the southern part of Chiapas (Southern part of Mexico) we have a lot of renal disease and patients in peritoneal or hemo dialysis, with a higher incidence than the rest of the country; do you know of a relation between the work in plantations of banana, coffee, cotton and the such and renal failure? http://internacional.elpais.com/internacional/2013/05/14/actualidad/1368496548_623955.html
http://www.ncbi.nlm.nih.gov/pubmed/20924282
There are many articles about nicotine(tobacco) as aggravators of Nephropathy.
This is a very complicated question as it is difficult to separate the intensity of work from other exposures that may occur at plantations. My best guess to date is that there are a lot of causes for kidney disease in people in this region, but kidney disease definitely seems to be present in much higher numbers of young men than would be expected. I suspect that very difficult working conditions in severe heat contribute (by causing repeated subclinical acute kidney injury/acute renal failure), perhaps in conjunction with NSAIDS, certain antibiotics and other potential nephrotoxins. Supporting heat is that this is more common in the hottest growing regions and in the most vigorous tasks. What these other nephrotoxins are, if any, remains unknown and an important topic for future research.
Thank you all for your excellent answers. Research theme for the future..., Great response Daniel.
we have studied AKI at our institution based in Pakistan, over last 24 years.It is very difficult to tell about incidence of AKI related to exposure to above mentioned plants. But certainly people working in very hot weather in open fields in this country and unchecked use of over the counter medications, many of which are known to cause nephrotoxicity, could be a possible contributing factor.
other toxins in our experience are snake venom, scorpion stings, hair colouring dye, copper sulphate etc.
The high prevalence of chronic kidney disease (CKD) in Central America and particularly in Nicaragua is a RECENT health problem, since CKD prevalence increased during the last decade. Curiously, CKD occur mainly in young men working in sugar cane farm. CKD is largely caused by hypertension and diabetes, but most of these patients have neither. Thus multifactorial causes may be suggested.
According to the recent publications, CKD seems to be secondary to a tubular and interstitial process, proteinuria being absent or low (1+).
Working hard in heat and moistness induce rapidly a salt wasting and dehydration, - rehydration without NaCl may induce hyponatremia, cerebral edema and then vomiting-, rhabdomyolysis due hard working but also perhaps polymorphism. Heat stress seems to be one of the major factors of this very particular cause of CKD. Nephrotoxic drugs may have also an important role, since self-medication and chronic exposure to NSAID are frequent. Furthermore, stones and dysuria are frequently reported. Of course industrial chemical cannot be excluded, but the fact that young workers CKD incidence is lower in high altitude villages where farming conditions are similar may be taken into consideration. Anyhow, all these hypotheses do not explain the “recent” increment of CKD incidence in this population.
Thus, high CKD incidence in young workers free of hypertension and diabetes might be secondary to heat stress, environmental agents or conditions, chronic NSAID exposure. To prevent Heat stress and rhabdomyolysis, workers should frequently drink purified water or soft drinks associated with salted crackers or salted foods.
It will of interest to test the hypothesis of a specific polymorphism, since most of these young patients requiring RRT are, I suppose, on the kidney transplantation least
Renal failure can be due to Acute Kidney Injury ( AKI ) or Chronic Kidney Disease ( CKD ) . Data available seems to suggest that renal failure in this group of patients is CKD due to Chronic Tubulo-Interstital Nephritis ( CTIN ) , which may be due to NSAIDS / Native drugs / Native plant toxins . Hypovolemia due to salt depletion in hot weather may cause AKI on CKD . This would be devastating as mild CKD would rapidly progress to severe CKD . It is very essential to screen for CKD early & these patients should be adequately hydrated to prevent rapid decline in GFR . CKD due CTIN would progress slowly as there is no nephrotic range proteinuria or hypertension & is usually a salt losing renal disease . The cause of CKD should be evaluated as early as possible by epidemiological survey . This reminds me of Phenacetin nephrotoxicity , which was a cause of CKD in the early 1980's & was eliminated by withdrawing this drug . In developing countries , conservative therapy to prevent progression of CKD should be given top priority.
I agree with the fact that this disease look like the Phenacetin nephrotoxicity, largely used in the north of Europe. In contrast with this largely documented chronic tubulo-interstitial process, even if we cannot exclude NSAIDS, NSAIDS chronic renal toxicity remains still debated. At evidence NSAID induce reversible Acute Kidney injury particularly in older adults with or without previous kidney disease. In older patients with previous CKD, NSAIDS may play a role in the evolution of the CKD. But, according to the three years follow-up of a very large cohort, incidence of renal failure seems not affected by chronic use of NSAID (FIG 1 of Concomitant use of ibuprofen and paracetamol and the risk of major clinical safety outcome by de Vries et al, BJCP april 2010), the role of NSAIDS in the Central America CKD disease should be rediscussed, just a cofouding factor?
I agree with Francois Brivet that apart from Phenacetin , NSAIDS cause only reversible AKI . The only way to confirm the diagnosis would be to send the kidney tissues of patients who have died , to centres of excellence for detailed chemical & histopathological evaluation . In addition , it should be kept in mind that other causes of tropical AKI such as leptospirosis , malaria , community acquired sepsis & acute diarrheal diseases are excluded , as many of them complain of fever , while working in the sugarcane fields . These disease may aggravate the pre existing CKD . AKI definitely remains a serious threat in these patients .
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