title: Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities.
abstract: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied.
  
  
  
  Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities.
  
  
  
  A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18-59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed.
  
  
  
  Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), ß2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%).
  
  
  
  This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.
authors.affiliation: Nephrology Institute, Havana, Cuba. raul.herrera@infomed.sld.cu).
authors.forename: Raúl
authors.initials: R
authors.lastname: Herrera
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Orantes
authors.forename: Miguel
authors.initials: M
authors.lastname: Almaguer
authors.forename: Pedro
authors.initials: P
authors.lastname: Alfonso
authors.forename: Héctor D
authors.initials: HD
authors.lastname: Bayarre
authors.forename: Irma M
authors.initials: IM
authors.lastname: Leiva
authors.forename: Magaly J
authors.initials: MJ
authors.lastname: Smith
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Cubias
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Torres
authors.forename: Walter O
authors.initials: WO
authors.lastname: Almendárez
authors.forename: Francisco R
authors.initials: FR
authors.lastname: Cubias
authors.forename: Fabrizio E
authors.initials: FE
authors.lastname: Morales
authors.forename: Salvador
authors.initials: S
authors.lastname: Magaña
authors.forename: Juan C
authors.initials: JC
authors.lastname: Amaya
authors.forename: Edgard
authors.initials: E
authors.lastname: Perdomo
authors.forename: Mercedes C
authors.initials: MC
authors.lastname: Ventura
authors.forename: Juan F
authors.initials: JF
authors.lastname: Villatoro
authors.forename: Xavier F
authors.initials: XF
authors.lastname: Vela
authors.forename: Susana M
authors.initials: SM
authors.lastname: Zelaya
authors.forename: Delmy V
authors.initials: DV
authors.lastname: Granados
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vela
authors.forename: Patricia
authors.initials: P
authors.lastname: Orellana
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Hevia
authors.forename: E Jackeline
authors.initials: EJ
authors.lastname: Fuentes
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Mañalich
authors.forename: Raymed
authors.initials: R
authors.lastname: Bacallao
authors.forename: Mario
authors.initials: M
authors.lastname: Ugarte
authors.forename: María I
authors.initials: MI
authors.lastname: Arias
authors.forename: Jackelin
authors.initials: J
authors.lastname: Chávez
authors.forename: Nelson E
authors.initials: NE
authors.lastname: Flores
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Aparicio
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000383:Agriculture; D016573:Agrochemicals / Q000506:poisoning*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015992:Body Mass Index; D004544:El Salvador / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000032:analysis; D011203:Poverty; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D017678:Sex Distribution; D064890:Social Determinants of Health; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D016573:Agrochemicals; D015415:Biomarkers; D011108:Polymers; C045786:polyurea