title: Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational and environmental determinants.
abstract: Increase in the prevalence of chronic kidney disease (CKD) is observed in Central America, Sri Lanka and other tropical countries. It is named chronic interstitial nephritis in agricultural communities (CINAC). CINAC is defined as a form of CKD that affects mainly young men, occasionally women. Its aetiology is not linked to diabetes, hypertension, glomerulopathies or other known causes. CINAC patients live and work in poor agricultural communities located in CINAC endemic areas with a hot tropical climate, and are exposed to toxic agrochemicals through work, by ingestion of contaminated food and water, or by inhalation. The disease is characterized by low or absent proteinuria, small kidneys with irregular contours in CKD stages 3–4 presenting tubulo-interstitial lesions and glomerulosclerosis at renal biopsy. Although the aetiology of CINAC is unclear, it appears to be multifactorial. Two hypotheses emphasizing different primary triggers have been proposed: one related to toxic exposures in the agricultural communities, the other related to heat stress with repeated episodes of dehydration heath stress and dehydration. Existing evidence supports occupational and environmental toxins as the primary trigger. 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.
authors.affiliation: Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Channa
authors.initials: C
authors.lastname: Jayasumana
authors.affiliation: National Health Institute, Ministry of Health (MINSAL), San Salvador, El Salvador.
authors.forename: Carlos
authors.initials: C
authors.lastname: Orantes
authors.affiliation: Institute of Nephrology, Ministry of Public Health, La Habana, Cuba.
authors.forename: Raul
authors.initials: R
authors.lastname: Herrera
authors.affiliation: Institute of Nephrology, Ministry of Public Health, La Habana, Cuba.
authors.forename: Miguel
authors.initials: M
authors.lastname: Almaguer
authors.affiliation: Institute of Nephrology, Ministry of Public Health, La Habana, Cuba.
authors.forename: Laura
authors.initials: L
authors.lastname: Lopez
authors.affiliation: National Medical Sciences Information Center, Havana, Cuba.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Silva
authors.affiliation: Pan American Health Organization, Washington, DC, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Ordunez
authors.affiliation: Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
authors.forename: Sisira
authors.initials: S
authors.lastname: Siribaddana
authors.affiliation: Department of Health Science, California State University, Long Beach, CA, USA.
authors.forename: Sarath
authors.initials: S
authors.lastname: Gunatilake
authors.affiliation: Laboratory of Pathophysiology, University of Antwerp, Wilrijk, Belgium.
authors.forename: Marc E
authors.initials: ME
authors.lastname: De Broe
mesh_terms: D000383:Agriculture; D016573:Agrochemicals; D004781:Environmental Exposure / Q000009:adverse effects*; D014943:Global Health; D018882:Heat Stress Disorders / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D009395:Nephritis, Interstitial / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012931:Social Environment
chemical_list: D016573:Agrochemicals
keywords: chronic interstitial nephritis in agricultural communities; CINAC; dehydration; heat stress; herbicides