There is a growing incidence of chronic kidney disease (CKD) in Central America referred to as Mesoamerican Nephropathy
Patients tend to be young (30-50 years old), male, agricultural workers, and do not have a history of diabetes, hypertension, or obesity
Etiology remains unconfirmed but is likely multifactorial with contributors including: repeated dehydration, excessive NSAID use, toxins from sugarcane derived alcohol, and mild Leptospirosis infection.
Area of the world affected:
Highest prevalence in El Salvador and Nicaragua
Lower prevalence in Costa Rica and Guatemala
Relevance to the US physician:
Immigrants with Mesoamerican Nephropathy may present to the ED with acute on chronic kidney disease
Treatment guidelines are the same as for other CKD etiologies
Council patients on proper hydration during exertion, limiting NSAID use, and avoiding homemade alcohol consumption
Bottom Line:
Mesoamerican Nephropathy should be considered in Central American immigrants presenting to the ED with clinical and laboratory signs of CKD but without traditional risk factors.
University of Maryland Section of Global Emergency Health
Author: Emilie J.B. Calvello, MD, MPH & Alex Skog
References
Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis. 2014 Mar;63(3):506–20.
