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Anales de la Facultad de Ciencias Médicas (Asunción)

versión impresa ISSN 1816-8949

An. Fac. Cienc. Méd. (Asunción) vol.55 no.1 Asunción abr. 2022

https://doi.org/10.18004/anales/2022.055.01.13 

Articles

Impacts of the identification of chronic interstitial nephritis in farmers in Paraguay

Walter Eduardo Cabrera1  2 
http://orcid.org/0000-0002-4677-877X

Francisco Vicente Santa Cruz1  2 
http://orcid.org/0000-0001-5938-8853

1 Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Fisiopatología y Clínica Médica. Asunción, Paraguay.

2 Universidad Católica “Nuestra Señora de la Asunción”, Facultad de Ciencias Médicas, Cátedra de Fisiopatología y Clínica Médica. Asunción, Paraguay.


Mesoamerican nephropathy was initially described at the beginning of the current century in San Salvador, where an important group of young farmers presented with a clinic of chronic kidney disease of unknown etiology. Later this pathology was found in other countries on the Pacific coast and even on other continents outside of America. In all these countries, this sickness cause enormous health expenses, for example, the admission to chronic dialysis programs of patients, or simply the loss of work capacity.

At the IX Congress of the Paraguayan Society of Nephrology (2017), the nephrologist Guillermo Alvarez (Dominican Republic) presented an update on this condition, while the national nephrologist Dario Cuevas answered affirmatively to the following question: Is it possible to find Mesoamerican nephropathy in Paraguay?

After identifying a farmer in Itacurubí del Rosario with elevated serum creatinine and no data of systemic disease, high blood pressure or diabetes mellitus, a kidney biopsy is performed. The data obtained were published as a case report in one of the Journals of the International Society of Nephrology, Kidney Int Report, as the first case of this condition in Paraguay.

Chronic interstitial nephritis is a histological entity characterized by progressive scarring of the renal tubule interstitium, with tubular atrophy, infiltration of lymphocytes and macrophages, and interstitial fibrosis, and is studied by renal biopsy.

Mesoamerican nephropathy is characterized by elevated serum creatinine, non-nephrotic proteinuria in young men, without evidence of any risk factors for chronic kidney disease. No laboratory markers of this condition have been identified, so renal biopsy currently plays a central role in its evaluation and diagnosis.

Among other things, the identification of chronic interstitial nephritis in a community of farmers, leads us to important challenges to overcome: a. What is the prevalence of this condition among farmers in the country? B. What is the etiology of it? Also dehydration, heat, the use of pesticides and other chemicals, heavy metals could play an important role. Know precisely the etiology of the disease will lead to rational treatments, and know the prevalence and incidence will lead to defining public health policies on this disease.

Chronic dehydration and hypovolemia related to heat could play an important role in its appearance, although other researchers have achieved the use of toxic products during fumigation a central role in its genesis. In Paraguay, the results of a community monitoring of exposure to pesticides have been published with important data on the subject.

We believe that several research groups should be formed to study the impacts of this recently described disease in the country, in its different aspects

REFERENCIAS BIBLIOGRAFICAS

1. Jayasumana C, Orantes C, Herrera R, et al. Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational, and environmental determinants. Nephrol Dial Transplant. 2017;32:234-241. [ Links ]

2. Herrera Valdés R, Almaguer López M, Orantes Navarro CM, et al. Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities. Clin Nephrol. 2020;93: 60-67. https://doi.org/10.5414/CNP92S110Links ]

3. Cabrera WE, Vervaet BA, Scheurs G, Nast CC, Santa-Cruz F, De Broe ME. Chronic Interstitial Nephritis in Agricultural Communities: A Patient in Paraguay. Kidney Int Rep (2022); https://doi.org/10.1016/j.ekir.2022.02.019Links ]

4. Johnson RJ, Wesseling C, Newman LS. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med. 2019;380:1843-1852. https://doi.org/10.1056/ NEJMra1813869Links ]

5. Vervaet BA, Nast CC, Jayasumana C, et al. Chronic interstitial nephritis in agricultural communities is a toxin-induced proximal tubular nephropathy. Kidney Int. 2020;97:350-369. https:// doi.org/10.1016/j.kint.2019.11.009Links ]

6. Flores L, Gamarra G, González de Bóveda H, Paredes M. Monitoreo comunitario para la vigilancia de exposición al uso de plaguicidas en Paraguay, Año 2018. Rev. salud publica Parag. 2019;9( 1 ): 9-18. Disponible en: http://scielo.iics.una.py/scielo.php?script=sci_arttext&pid=S2307-33492019000100009&lng=es. https://doi.org/10.18004/rspp.2019.junio.9-18. [ Links ]

Received: March 22, 2022; Accepted: March 31, 2022

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