Blog entry by Meguid El Nahas

Anyone in the world


Am J Kidney Dis. 2017 Apr;69(4):552. doi: 10.1053/j.ajkd.2016.09.029.

Kidney Disease of Unknown Cause in Agricultural Laborers (KDUCAL) Is a Better Term to Describe Regional and Endemic Kidney Diseases Such as Uddanam Nephropathy.

Subramanian SJavaid MM1

MesoAmerican Nephropathy (MAN)
Chronic Kidney Disease of Unknown Etiology (CKDu)
chronic interstitial nephritis in agricultural communities (CINAC)
https://www.ncbi.nlm.nih.gov/pubmed/?term=sri+lanka%2C+CKD%2C+De+Broe
 
Now KDUCAL...
 
Are we looking for a name for renal insufficiency that affects labourers in extreme heat conditions...?!
 
Perhaps, we should call it...
CKDh (Chronic Kidney Disease heat induced...)
or even
CKDd (Chronic Kidney Disease dehydration induced...)
 
all these nephropathies observed amongst agricultural workers exposed to extreme heat conditions and who are chronically wasted and dehydrated include those noted amongst:
Sugar cane and other crop labourers in Central America
MesoAmerican Nephropathy
 
Including that observed in agricultural workers in India; Uddanam
https://www.ncbi.nlm.nih.gov/pubmed/27209444
 
In Cuba, Columbia, India, Sri Lanka, Egypt and elsewhere, those workers suffering form CKD may simply suffer from chronic dehydration in people exposed to long period of heat and related stress:
https://www.ncbi.nlm.nih.gov/pubmed/24717833
 
However, additional agricultural related factors have been raised by some, such as my good friend Prof Marc De Broe, who wrote:
https://www.ncbi.nlm.nih.gov/pubmed/?term=sri+lanka%2C+CKD%2C+De+Broe
 
"The heat stress and dehydration hypothesis, however, cannot explain: why the incidence of CINAC went up along with increasing mechanization of paddy farming in the 1990s; the non-existence of CINAC in hotter northern Sri Lanka, Cuba and Myanmar where agrochemicals are sparsely used; the mosaic geographical pattern in CINAC endemic areas; the presence of CINAC among women, children and adolescents who are not exposed to the harsh working conditions; and the observed extra renal manifestations of CINAC. This indicates that heat stress and dehydration may be a contributory or even a necessary risk factor, but which is not able to cause CINAC by itself."
 
In Sri Lanka, heavy metals, and trace elements including cadmium, strontium, etc... contamination of foodstuff has been raised:
https://www.ncbi.nlm.nih.gov/pubmed/26701260
as well as excessive high fluoride water content:
https://www.ncbi.nlm.nih.gov/pubmed/20853020
 
In the meanwhile...and until the etiology is settled....nephrologists will continue to look for a name...
 
same story as many decades ago when Balkan Nephropathy...was atributed to mycotoxins and ochratoxin...and it  became known as Aristolochic Acid Nephropathy (AAN)...
or is it?...
https://www.ncbi.nlm.nih.gov/pubmed/27871899
 
 
 
 
 
 
[ Modified: Thursday, 1 January 1970, 1:00 AM ]

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