4.1 Review

The unresolved epidemic of chronic kidney disease of uncertain origin (CKDu) around the world: A review and new insights

Journal

CLINICAL NEPHROLOGY
Volume 95, Issue 2, Pages 65-80

Publisher

DUSTRI-VERLAG DR KARL FEISTLE
DOI: 10.5414/CN110186

Keywords

Meso-American nephropathy; chronic kidney disease of unknown cause (CKDu); interstitial nephritis; environmental kidney disease

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Mesoamerican nephropathy (MeN) is a form of chronic kidney disease with unknown causes, characterized by tubulo-interstitial nephritis and glomerulosclerosis. The potential causes may involve exposure to water contaminants combined with volume depletion.
Epidemiology: An increasing number of inhabitants of Central America have developed a form of chronic kidney disease of unknown cause, named Mesoamerican nephropathy (MeN). Because similar epidemics have been reported in other parts of the world, such as Sri Lanka, India, Egypt, and Tunisia, this condition is currently called chronic kidney disease of uncertain origin (CKDu). Clinical presentation: This disease is characterized by minimal proteinuria, leukocyturia, hyperuricemia, hypokalemia reduced glomerular filtration rate, and renal tubular dysfunctions. Pathology: The kidneys manifest tubulo-interstitial nephritis and glomerulosclerosis. Electron microscopy shows large dimorphic lysosomes with dark electron-dense aggregates. Potential causes: The cause(s) of this disease remain largely unknown. Several hypotheses have been proposed including infections, dehydration, global warming, hyperuricemia, exposure to agro-chemicals or heavy metals, and genetic susceptibility. This review addresses a mounting body of evidence suggesting that the disease may be the result of exposure to a variety of water contaminants combined with volume depletion. Therapy: Absent a clear understanding of the causes of the disease, no specific therapeutic interventions can be recommended. Preliminary studies suggest that reduction of working hours, frequent rest in shaded area, and administration of purified water may reduce the risk of CKDu.

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