Clinical Characterization and histopathology of nephropathy in Salvadorian agricultural communities
Carlos Navarro Orantes
Presentation: 29.10.2013, 01:45 pm [Video]
Discussion: 29.10.2013, 02:00 pm [Discussion]
Introducción: An epidemic of chronic kidney disease (CKD) of unknown etiology and unassociated with traditional risk factors is emerging in Central America, affecting primarily agricultural communities. In El Salvador, Ministry of Health data for 2012 indicate that in the hospital system, end-stage renal disease (ESRD) was the number one cause of death among adult men and the fifth cause of death among women. The disease has not been fully studied, nor has case definition been well established. Objectives: Describe the clinical, physiopathologic, imaging, histopathologic, toxic and epidemiologic manifestations of chronic kidney disease of unknown etiology (CKDue) and propose criteria for case definition. Methods: The study carried out: analysis of social determinants and psychological evaluation; A descriptive and correlational clinical study was carried out in a sample of 46 participants, identified through population-based epidemiologic screening and who provided informed consent. Inclusion criteria: aged 18–59 years; both sexes; with CKDue in stages 2, 3a and 3b; or CKD in stages 3a and 3b with diabetes or hypertension, without proteinuria. Exclusion criteria: patients with CKD of known etiology; HIV-positivity; and any clinical or social causes that prevented participation. Clinical characterization: CKD of Salvadoran agricultural communities is associated with social determinants in these communities. Main risk factors: environmental toxins, agricultural worker, male, profusive sweating, NSAID use, dyslipedemia . Main renal symptoms: polyuria with nicturia, urethral bladder irritation, and foamy urine. Main general symptoms: cephalea, arthralgias, asthenia and cramps. Renal function characterized by: loss of magnesium, phosphorous, sodium, potassium in urine, with electrolyte polyuria and metabolic alkalosis . Main renal damage markers are microalbuminuria, beta 2 microglobulin and N-GAL. High blood pressure is not relevant and cardiovascular function is preserved. Distal arterial damage is present in lower extremities. Presence of fatty liver with normal enzymes. Alteration of osteotendinous reflexes and neurosensorial hypoacusis. Histopathologic characteristics: Chronic tubule interstitial nephropathy was observed from first through most advanced stages. The dominant primary damage was tubule interstitial fibrosis, with secondary glomerular and vascular damage. The same histopathological pattern with differing intensities was seen in all cases studied, regardless of crop type, age, sex, or place of residence. Keywords: Chronic Kidney disease, tubulointerticial nephritis, environment, toxicology.