Mesoamerican nephropathy

Mesoamerican nephropathy (MeN) is an endemic, non-diabetic, non-hypertensive chronic kidney disease (CKD) characterized by reduced glomerular filtration rate (GFR) with mild or no proteinuria and no features of known primary glomerular diseases. MeN is prevalent in agricultural communities along the Pacific Ocean coastal lowlands Mesoamerica, including southern Mexico, Guatemala, El Salvador, Nicaragua, Honduras and Costa Rica. Although most cases have been described among agricultural workers, MeN has also been described in other occupations, including miners, brick manufacturers, and fishermen. A common denominator among these occupations is that they are outdoor workers who reside in rural areas in hot and humid climates.

The MeN epidemic in Central America extends along a nearly 1000 kilometer stretch of the Pacific coast. Among the countries that this span encompasses, CKD is the second leading cause of death in El Salvador and Nicaragua, third leading cause in Costa Rica, and fourth leading cause in Panama. El Salvador and Nicaragua have the highest rates of kidney disease mortality in the world; among men, the mortality rate from CKD is approximately six-fold higher in El Salvador and five-fold higher in Nicaragua than the median global rate, and 1.5-2 times higher than the rate in Libya, the third-highest country on the list. The disease has devastated many of the communities where it exists and has overwhelmed healthcare systems in affected countries, causing unknown morbidity and tens of thousands of deaths over the last 20 years in Mesoamerica alone.

MeN is generally diagnosed in men in their twenties or thirties, and initially presents as a progressive decline in GFR without notable proteinuria. Traditional risk factors for CKD, including hypertension and diabetes mellitus, are generally absent.