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Occupational Kidney Disease in Pacific Coast Central America

Occupational Kidney Disease in Pacific Coast Central America

There is a mystery epidemic of Chronic kidney disease of unknown cause (CKDu) affecting agricultural and non-agricultural communities in Mesoamerica. This disease has reduced the life expectancy of thousands and caused the deaths of tens of thousands young males and females.

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About

The community-based cohort study aims is to investigate the natural history of, and factors associated with decline kidney function in an apparently healthy young rural population at Northwest Nicaragua.

Who we are

We are a team of epidemiologists, nephrologists, statisticians, occupational doctors and other experts from universities and organizations working together to investigate chronic kidney disease of unknown cause in Nicaragua.

About
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We have started the first community-based longitudinal study investigating the natural history of a new forms of chronic kidney disease of unknown origin and also call Mesoamerican Nephropathy in León and Chinandega departments, Nicaragua. 350 apparently healthy young population aged 18-30 years old (M:F 3:1) without previous diagnose of diabetes mellitus, hypertension and /or kidney problems were recruited after performed community census.

This study design has several advantages. Firstly, this type of cohort represents the entire at-risk population because all males were included and females were random selected. Workers from all occupations were recruited. Secondly, the cohort studies dealing with the reverse-causation. Third, we can make comparison between and within persons.

The study visits take place twice a year (during harvest and non-harvest season) where we collect a variety of exposure, e.g., socio-demographics data, current occupation, labour history, environmental exposure (heat exposure, pesticide, etc), infectious disease, healthy and unhealthy habits (water intake, alcohol consumption, smoking), dehydration symptoms, self-medication, etc.

Furthermore, we are collecting biological samples (blood and urine) from each study visit. Serum and urine aliquots were separate and storage in biobank at -80ºC. Also, water samples were collected during the dry and rainy season.

The samples have been analysing in different laboratories. For  example: Heavy metal and water quality was analysed at Imperial College London, serum creatinine and cystatin c at Nuffield Department of Population Health Wolfson Laboratories from the Clinical Trials Services Unit (CTSU), Oxford University, pesticide at laboratory at Occupational and Environmental Medicine (OEM) in Lund, kidney biomarkers (ACR and NGAL) at laboratory of Nephrology Center, UCL. and urinary metals and metaloids were measured at Health and Safety Environmental Laboratory.

Who we are
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Professor Neil Pearce (LSHTM)
Dr Ben Caplin (UCL)
Professor Dorothea Nitsch (LSHTM)
Professor Liam Smeeth (LSHTM)
Dr Marvin González-Quiroz (LSHTM and CISTA/UNAN-León)
MSc. Evangelia Smpokou (UCL)
Dr Aurora Aragón (CISTA/UNAN-León)
Dr Catharina Wesseling (Karolinska Institute)
Publications
Scientific Papers
Decline in kidney function among apparently healthy young adults at risk of Mesoamerican nephropathy
Marvin Gonzalez-Quiroz, Evangelia-Theano Smpokou, Richard J. Silverwood, Armando Camacho, Dorien Faber, Brenda La Rosa Garcia, Amin Oomatia, Michael Hill, Jason Glaser, Jennifer Le Blond, Catharina Wesseling, Aurora Aragon, Liam Smeeth, Neil Pearce, Dorothea Nitsch, Ben Caplin
2018
JASN August 2018 29: 2200-2212. June 15, 2018, doi:10.1681/ASN.2018020151
Rationale, description and baseline findings of a community-based prospective cohort study of kidney function amongst the young rural population of Northwest Nicaragua
Marvin González-Quiroz, Armando Camacho, Dorien Faber, Aurora Aragón, Catharina Wesseling, Jason Glaser, Jennifer Le Blond, Liam Smeeth, Dorothea Nitsch, Neil Pearce and Ben Caplin
2017
BMC NephrologyBMC series – open, inclusive and trusted201718:16 https://doi.org/10.1186/s12882-016-0422-4
What do epidemiological studies tell us about chronic kidney disease of undetermined cause in Meso-America? A systematic review and meta-analysis
Marvin González-Quiroz, Neil Pearce, Ben Caplin, Dorothea Nitsch
2017
Clinical Kidney Journal, sfx136, https://doi.org/10.1093/ckj/sfx136