Acute kidney injury in rural workers: An environmental-stress nephropathy
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Acute kidney injury
Mesoamerican nephropathy
Chronic interstitial nephritis of agricultural communities (CINAC)

How to Cite

Musso CG, Aroca-Martínez G, Avendaño-Echavez L, Cadena-Bonfanti A, Castillo L, González-Torres H, Conde JC, Navarro-Quiroz E, Peña-Vargas W, Hernandez S, Velez-Verbel M de los Ángeles, Perez R, Sierra A, Rua Z, Palmera J, Terrasa S. Acute kidney injury in rural workers: An environmental-stress nephropathy. Rev. Colomb. Nefrol. [Internet]. 2023 Nov. 15 [cited 2024 Feb. 26];10(3). Available from:


Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor.

Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. 

Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). 

Results: Of the 28 young men workers evaluated, 5 (18%) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p?0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. 

Conclusions: Eighteen percent (18%) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.
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Kupferman J, Ramírez-Rubio O, Amador JJ, López-Pilarte D, Wilker EH, Laws RL, et al. Acute Kidney Injury in Sugarcane Workers at Risk for Mesoamerican Nephropathy. Am J Kidney Dis. 2018 Oct;72(4):475-482.

González-Quiroz M, Pearce N, Caplin B, Nitsch D.What do epidemiological studies tell us about chronic kidney disease of undetermined cause in Meso-America? A systematic review and meta-analysis. Clin Kidney J. 2018 Aug; 11(4): 496–506.

Correa-Rotter R, García-Trabanino R. Mesoamerican nephropathy: a new chronic kidney disease of hihg local relevance. Acta Médica Grupo Ángeles. 2018;16(1):S16-S22.

Glaser J, Lemery J, Rajagopalan B, Diaz HF, García-Trabanino R, Taduri G et al. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy. Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1472-83.

Herath C, Jayasumana C, De Silva PM, De Silva PH, Siribaddana S, De Broe ME. Kidney Diseases in Agricultural Communities: A Case Against Heat-Stress Nephropathy. Kidney International Reports. 2018;3(2):271-280.

García R, Cerdas M, Madero M, Jakobsson K, Barnoya J, Crowe J, et al. Nefropatía mesoamericana: revisión breve basada en el segundo taller del Consorcio para el estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM). Revista nefrología latinoamericana. 2017;14(1):39-45.

Wijkstrom J, Leiva R, Elinder CG, Leiva S, Trujillo Z. Trujillo L, et al. Clinical and pathological characterization of Mesoamerican nephropathy: A new kidney disease in Central America. Am J Kidney Dis. 2013;62(5):908-918.

Kupferman J, Ramírez-Rubio O, Amador JJ, López-Pilarte D, Wilker EH, Laws RL, et al. Lesión renal aguda en trabajadores de la caña de azúcar en riesgo de nefropatía mesoamericana. Am J Kidney Dis. 2018;72(4):475-482.

Peraza S, Wesseling C, Aragon A, Leiva R, García-Trabanino RA, Torres C, et al. Decreased kidney function among agricultural workers in El Salvador. Am J Kidney Dis. 2012 Apr;59(4):531-40.

Aguilar D, Madero M. Untangling Mesoamerican Nephropathy American Journal of Kidney Diseases. National Kidney Foundation. 2018;72(4):469-471.

Johnson R, Wesseling C, Newman L. Chronic Kidney Disease of Unknown Cause in Agricultural Communities. N Engl J Med. 2019;380:1843-1852.

Correa-Rotter R, Wesseling C, Richard J. CKD of unknown origin in Central America: the case for a Mesoamerican Nephropathy. AJ Kidney Dis. 2014;63:506-520.

Barahona-Lopez D, Fajardo-Leitzelar F. Mesoamerica nephropathy: consequence of climate change? Rev Nefrol Dial Traspl. 2020;40(3):273-5.

Vervaet BA, D’Haese PC, Verhulst A. Environmental toxin-induced acute kidney injury. Clin Kidney Journal. 2017;10(6):747–758.

Hodgson LE, Walter E , Venn RM, Galloway R, Pitsiladis Y, Sardat F, et al. Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med. 2017 Jun 14;3(1):1-14

Pérez-Redondo R, Bustamante J, de Paz JA. Physical activity as a modifier of renal function. Historical review. Nefrología. 2002;22(1):15-23.

Furuto Y, Kawamura M, Namikawa A, Takahashi H, Shibuya Y, Mori T, et al. Non-urate transporter 1, non-glucose transporter member 9-related renal hypouricemia and acute renal failure accompanied by hyperbilirubinemia after anaerobic exercise: a case report. BMC Nephrology. 2019;20:433.

Ejaz AA, Mu W, Kang DH, Roncal C, Sautin YY, Henderson G, et al. Could Uric Acid Have a Role in Acute Renal Failure? CJASN. 2007;2(1):16-21.

Ejaz AA, Johnson RJ, Shimada M, Mohandas R, Alquadan KF, Beaver TM, et al. The Role of Uric Acid in Acute Kidney Injury. Nephron. 2019;142(4):275–283.

Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and chronic kidney disease: an enigma yet to be solved. Renal Failure. 2014 Oct;36(9):1351-9.

Beker B, Cervellera C, De Vito A, Musso CG. Human Physiology in Extreme Heat and Cold. Int Arch Clin Physiol. 2018;1(1).

Ajayi SO, Raji R, Michael QS, Adewole D, Akande T, Abiola B, et al. Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria. West Afr J Med. 2021 Jan;38(1):48-53.

Sato Y, Takahashi M, Yanagita M. Pathophysiology of AKI to CKD Progression. Semin Nephrol. 2020 Mar;40(2):206-215.

Hsu R, Hsu C. The role of acute kidney injury in chronic kidney disease. Semin Nephrol. 2016 Jul;36(4):283–292.

Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and Chronic Kidney Disease: An Enigma Yet to Be Solved. Ren Fail. 2014;36(9):1351–1359.

Giordano C, Karasik O, King-Morris K, Asmar A. Uric Acid as a Marker of Kidney Disease: Review of the Current Literature. Dis Markers. 2015 May;27: 382918.

Kamiyama M, Kataoka H, Moriyama T, Mochizuki T, Nitta K. Hyperuricemia as a Predictor of Progression of Chronic Kidney Disease: A Matched Cohort Analysis. Int J Clin Med. 2017;8(3):178-197.

Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int. 2015;87(4):792–799.

García-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador – A cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res. 2015;142:746-155.

Wesseling C, Aragón A, González M, Weiss I, Glaser J, Bobadilla N, et al. Kidney function in sugarcane cutters in Nicaragua - A longitudinal study of workers at risk of Mesoamerican nephropathy. Environ Res. 2016;147:125-132.

Herat H C, Jayasumana C, De Silva M, De Silva C, Siribaddana S, De Broe M. Kidney diseases in agricultural communities: A case against heat-stress nephropathy. Kidney Int Rep. 2018;3(2):271–280.

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