Chronic kidney disease of non-traditional causes (CKDu) in women of agricultural communities in El Salvador
Carlos M. Orantes, Raúl Herrera MD PhD DrSc, Miguel Almaguer MD, Laura López MD MS, Pedro Alfonso MD, Magaly J. Smith, Fabrizio E. Morales MD, Raymed Bacallao MD, Xavier F. Vela MD, Héctor D. Bayarre MD PhD
National Institute of Health-Ministry of Health of El Salvador
Presentation: Video available since xx.08.2014 [Video]
Discussion: 26.08.2014 [Discussion]
Introduction A chronic kidney disease of non-traditional causes (CKDu) epidemic has emerged in Central America and elsewhere, predominantly affecting male farmworkers. In El Salvador (2009) it was the second cause of death in men >18 years old. Disease causes have not been determined. Most research focuses on men; there are scarce data on women. Objectives Describe the clinical and histopathologic characteristics of CKDu in women of agricultural communities in El Salvador. Methodology A descriptive study was carried out in 10 women with CKDu stages 2, 3a and 3b. Researchers studied social determinants; clinically examined systems; hematological and biochemical analysis; urine sediment, renal damage markers, renal, cardiac, peripheral arteries, liver, pancreas and lung structure and functions. Kidney biopsies were performed. Data were collected on the Lime Survey platform and exported to SPSS 19.0. Results Patient distribution by stages: 2 (70%), 3a (10%), 3b (20%). Social determinants: poverty and related factors. Occupation: agricultural 7; non-agricultural 3. Risk factors: agrochemical exposure 100%; farmworkers 70%, profuse sweating 20%; malaria 50%, NSAIDs 40%; hypertension 40%, Symptoms: nicturia 50%; dysuria 50%; arthralgia 70%; asthenia 50%; cramps 30%. Renal markers: Albumin Creatinine Ratio > 300 mg/g 90%; B2 microglobulin and NGAL 40%. Kidney function: hypermagnesuria 100%; hyperphosphaturia 50%, hypercalciuria 40%; hypernatruria 30%; hyponatremia 60%, hypocalcemia 50%. Doppler: tibial artery damage40%. Neurological: Reflex disorders 30%; Babinski and myoclonus 20%. Neurosensorial hypoacusis 70%, Histopathology: chronic tubular interstitial nephropathy. Conclusions CKDu in women is a chronic tubulointerstitial nephropathy with extrarenal symptoms, which cannot be attributed to the disease. Key words: chronic kidney disease, occupational disease, tubulointersticial nephropathy, nephrotoxicity, renal ischemia, social determinants, El Salvador