Is CKD of unknown cause (CKDu) or Mesoamerican nephropathy (MeN) due to climate change?
CKD of unknown cause (CKDu) or Mesoamerican nephropathy (MeN; also known as Mesoamerican endemic nephropathy), is a chronic kidney disease (CKD) that especially affects Central America and parts of Asia. It has also been reported in Africa, the Middle East and South America.
It typically occurs in young and middle aged agricultural labourers, who work in manual labour, particularly in agriculture, such as sugarcane and rice farming. They often come from low income, rural populations.
It is prevalent in El Salvador, Nicaragua, Guatemala, Mexico, Honduras and Costa Rica. But it has also been described in Egypt, China, Peru, Sri Lanka, India, and other countries.
There is no universally accepted global definition for CKDu, making its study complex.
But we do know its a progressive form of tubulointerstitial nephritis that can lead to CKD and eventually end-stage renal failure (ESRF) and death. This is partly due to lack of dialysis facilities in developing countries.
It is characterised by reduced glomerular filtration rate, mild or no proteinuria, and no features of primary glomerular disease. CKDu is non-diabetic and non-hypertensive, and is not caused by traditional risk factors like diabetes and hypertension. The pathological findings are nonspecific.
What causes CKDu? Is climate change involved?
The cause of CKDu remains unclear. Current theories include some combination of environmental and occupational factors; such as heat stress, dehydration, agrochemicals (pesticides, herbicides, fertilisers), heavy metals (cadmium, lead, arsenic), water sources, and infection – and climate change may make it worse.
“This can be considered the first disease that’s related to climate change”
Dr. Roberto Lucchini, public health professor at Mount Sinai’s Icahn School of Medicine in New York City.
Recent studies also suggest the problem is even starting to affect outdoor workers in warmer parts of the USA, including California and Florida. Lucchini says, “.. if this continues as a general trend towards increased temperature, this is concerning”.
What is the treatment for CKDu?
There is no specific treatment for CKDu. Management focuses on controlling symptoms and slowing the progression of the disease through hydration, avoiding nephrotoxic substances, and dialysis or kidney transplantation in advanced cases.
Summary
We have discussed whether CKD of unknown cause (CKDu) or Mesoamerican nephropathy (MeN) is due to climate change. Possibly, but the precise cause(s) is/are currently unclear. It may multifactorial.
Other resources
What is CKDu?
A new era of climate medicine (Sorensen, 2019)
Review article: Polo, 202o
Last Reviewed on 19 May 2024