Acute kidney injury in rural workers: An environmental-stress nephropathy

Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity o...

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Autores:: Musso, Carlos G.
Aroca-Martínez, Gustavo
Avendaño-Echavez, Lil
Cadena-Bonfanti, Andrés
Castillo, Luis
González-Torres, Henry
Conde, Juan C.
Navarro-Quiroz, Elkin
Peña-Vargas, William
Hernandez, Sandra
Velez-Verbel, María de los Ángeles
Perez, Rafael
Sierra, Angélica
Rua, Zenen
Palmera, Jorge
Terrasa, Sergio

Tipo de recurso:

Fecha de publicación:: 2023

Institución:: Universidad Simón Bolívar

Repositorio:: Repositorio Digital USB

Idioma:: eng

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dc.title.eng.fl_str_mv	Acute kidney injury in rural workers: An environmental-stress nephropathy
dc.title.translated.spa.fl_str_mv	Lesión renal aguda en trabajadores rurales: una nefropatía por estrés ambiental
title	Acute kidney injury in rural workers: An environmental-stress nephropathy
spellingShingle	Acute kidney injury in rural workers: An environmental-stress nephropathy Acute kidney injury Chronic interstitial nephritis of agricultural communities (CINAC) Mesoamerican nephropathy Lesión renal aguda Nefritis intersticial crónica de comunidades agrícolas (CINAC) Nefropatía mesoamericana
title_short	Acute kidney injury in rural workers: An environmental-stress nephropathy
title_full	Acute kidney injury in rural workers: An environmental-stress nephropathy
title_fullStr	Acute kidney injury in rural workers: An environmental-stress nephropathy
title_full_unstemmed	Acute kidney injury in rural workers: An environmental-stress nephropathy
title_sort	Acute kidney injury in rural workers: An environmental-stress nephropathy
dc.creator.fl_str_mv	Musso, Carlos G. Aroca-Martínez, Gustavo Avendaño-Echavez, Lil Cadena-Bonfanti, Andrés Castillo, Luis González-Torres, Henry Conde, Juan C. Navarro-Quiroz, Elkin Peña-Vargas, William Hernandez, Sandra Velez-Verbel, María de los Ángeles Perez, Rafael Sierra, Angélica Rua, Zenen Palmera, Jorge Terrasa, Sergio
dc.contributor.author.none.fl_str_mv	Musso, Carlos G. Aroca-Martínez, Gustavo Avendaño-Echavez, Lil Cadena-Bonfanti, Andrés Castillo, Luis González-Torres, Henry Conde, Juan C. Navarro-Quiroz, Elkin Peña-Vargas, William Hernandez, Sandra Velez-Verbel, María de los Ángeles Perez, Rafael Sierra, Angélica Rua, Zenen Palmera, Jorge Terrasa, Sergio
dc.subject.eng.fl_str_mv	Acute kidney injury Chronic interstitial nephritis of agricultural communities (CINAC) Mesoamerican nephropathy
topic	Acute kidney injury Chronic interstitial nephritis of agricultural communities (CINAC) Mesoamerican nephropathy Lesión renal aguda Nefritis intersticial crónica de comunidades agrícolas (CINAC) Nefropatía mesoamericana
dc.subject.spa.fl_str_mv	Lesión renal aguda Nefritis intersticial crónica de comunidades agrícolas (CINAC) Nefropatía mesoamericana
description	Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor. Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). Results: Of the 28 young men workers evaluated, 5 (18 %) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p<0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. Conclusions: Eighteen percent (18 %) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.
publishDate	2023
dc.date.accessioned.none.fl_str_mv	2023-11-16T13:59:49Z
dc.date.available.none.fl_str_mv	2023-11-16T13:59:49Z
dc.date.issued.none.fl_str_mv	2023
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dc.type.spa.eng.fl_str_mv	Artículo científico
dc.identifier.citation.spa.fl_str_mv	Musso CG, Aroca-Martínez G, Avendaño-Echavez L, Cadena-Bonfanti A, Castillo L, Gonzàlez-Torres H, et al. Acute kidney injury in rural workers: An environmentalstress nephropathy. Rev. Colomb. Nefrol. 2023; 10(3), e670. https://doi.org/10.22265/acnef.10.3.670
dc.identifier.issn.none.fl_str_mv	23897708 25005006(en línea)
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12442/13428
dc.identifier.doi.none.fl_str_mv	http://doi.org/10.22265/acnef.10.3.670
dc.identifier.url.none.fl_str_mv	https://revistanefrologia.org/index.php/rcn/article/view/670/1068
identifier_str_mv	Musso CG, Aroca-Martínez G, Avendaño-Echavez L, Cadena-Bonfanti A, Castillo L, Gonzàlez-Torres H, et al. Acute kidney injury in rural workers: An environmentalstress nephropathy. Rev. Colomb. Nefrol. 2023; 10(3), e670. https://doi.org/10.22265/acnef.10.3.670 23897708 25005006(en línea)
url	https://hdl.handle.net/20.500.12442/13428 http://doi.org/10.22265/acnef.10.3.670 https://revistanefrologia.org/index.php/rcn/article/view/670/1068
dc.language.iso.eng.fl_str_mv	eng
language	eng
dc.rights.*.fl_str_mv	Attribution-NonCommercial-NoDerivatives 4.0 Internacional
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dc.format.mimetype.spa.fl_str_mv	pdf
dc.publisher.spa.fl_str_mv	Asociación Colombiana de Nefrología e Hipertensión Arterial
dc.source.spa.fl_str_mv	Revista Colombiana de Nefrología Rev. Colomb. Nefrol.
dc.source.none.fl_str_mv	Vol. 10 No.3, (2023)
institution	Universidad Simón Bolívar
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spelling	Musso, Carlos G.e1f82fb4-05f8-40b4-8f34-3bd432a0baf4Aroca-Martínez, Gustavoef65933f-3af8-4323-9a75-9d00de17e70aAvendaño-Echavez, Lile39b3329-5341-44a3-af85-be734dee7edeCadena-Bonfanti, Andrésef1cb12d-618e-46bd-aafd-4064f44fdcbfCastillo, Luis0ae06994-632b-44f5-9bd1-d1e6a9865378González-Torres, Henry2648cf97-1595-403c-ae64-394e49ba0efdConde, Juan C.d1e50ee1-3f49-468b-b756-3c0c4d087ac4Navarro-Quiroz, Elkinb7f1ab18-ac07-40cf-9df1-f25f0c54e259Peña-Vargas, William41bb073e-db09-43a0-b684-a5ce46c9cd5dHernandez, Sandrabf3a8fef-54ca-41e6-ba3e-48f535dccc31Velez-Verbel, María de los Ángeles025df3fc-ad04-4255-9a8a-314097a70b98Perez, Rafael341148cb-4228-4db8-8435-53d544d2dfd2Sierra, Angélicacff7b5fb-2ee9-497a-882d-86933087c754Rua, Zenen332aeb5d-4d68-4eb6-9cc5-e09ab2cb435fPalmera, Jorgeb4bcf3d7-430d-4ea7-a532-cfe1406e1618Terrasa, Sergiod05980ed-ca36-43c9-9784-44186e6c93ea2023-11-16T13:59:49Z2023-11-16T13:59:49Z2023Musso CG, Aroca-Martínez G, Avendaño-Echavez L, Cadena-Bonfanti A, Castillo L, Gonzàlez-Torres H, et al. Acute kidney injury in rural workers: An environmentalstress nephropathy. Rev. Colomb. Nefrol. 2023; 10(3), e670. https://doi.org/10.22265/acnef.10.3.6702389770825005006(en línea)https://hdl.handle.net/20.500.12442/13428http://doi.org/10.22265/acnef.10.3.670https://revistanefrologia.org/index.php/rcn/article/view/670/1068Introduction: Mesoamerican nephropathy is a tubule-interstitial nephropathy whose etiology is still unknown. However, clinical cases like Mesoamerican nephropathy have been described in other geographically distant and ethnically diverse regions. Still, they all have a common factor: the intensity of heat and rural physical labor. Objective: To study whether this entity could occur among rural workers in a non-Mesoamerican region with similar climatic and working conditions, in the Colombian Caribbean countryside, and to consider how much repetitive dehydration could weigh in its pathogenesis. Methodology: An observational study was carried out, based on field work in a farm in Sitio Nuevo (Colombia) with 28 rural worker volunteers (rice fields), who were measured for weight, blood pressure, and blood and urine samples to measure electrolytes and osmolarity, at 2 times of the day (morning and evening). Results: Of the 28 young men workers evaluated, 5 (18 %) presented a significant increase in serum creatinine during the day (0.8±0.15 vs 1.2±0.17, p<0.001). The volume of water ingested by the workers was highly variable (2,861 ± 1,591 cc). There was a significant increase in serum sodium (p<0.001), and urinary osmolarity (p=0.01) values between morning and afternoon values in these 5 patients. Conclusions: Eighteen percent (18 %) of the workers evaluated developed parameters compatible with acute kidney injury and dehydration during the workday in the Colombian Caribbean countryside.Introducción: la nefropatía mesoamericana es una nefropatía túbulo-intersticial cuya etiología aún se desconoce. Sin embargo, se han descrito casos clínicos similares a esta en otras regiones geográficamente distantes y étnicamente diversas. Aun así, todos tienen un factor común: la intensidad del calor y el trabajo físico rural. Objetivo: estudiar si esta entidad podría presentarse entre trabajadores rurales de una región no mesoamericana con condiciones climáticas y laborales similares, en el campo del Caribe colombiano y considerar cuánto podría pesar en su patogénesis la deshidratación repetitiva. Materiales y metodología: se realizó un estudio observacional, basado en un trabajo de campo en una finca de Sitio Nuevo (Colombia) en 28 voluntarios trabajadores rurales (arrozales), a quienes se les tomó peso, presión arterial y muestras de sangre y orina para medir electrolitos y osmolaridad, en 2 momentos del día (mañana y tarde). Resultados: de los 28 trabajadores jóvenes evaluados, 5 (18 %) presentaron aumento significativo de la creatinina sérica durante el día (0,8±0,15 vs 1,2±0,17, p<0,001). El volumen de agua ingerido por los trabajadores fue muy variable (2.861 ± 1.591 cc). Hubo un aumento significativo en los valores de sodio sérico (p<0,001) y osmolaridad urinaria (p=0,01) entre los valores de la mañana y la tarde en estos 5 pacientes. Conclusión: el dieciocho por ciento de los trabajadores evaluados desarrolló parámetros compatibles con daño renal agudo y deshidratación durante la jornada laboral en el campo del Caribe colombiano.pdfengAsociación Colombiana de Nefrología e Hipertensión ArterialAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Revista Colombiana de NefrologíaRev. Colomb. Nefrol.Vol. 10 No.3, (2023)Acute kidney injuryChronic interstitial nephritis of agricultural communities (CINAC)Mesoamerican nephropathyLesión renal agudaNefritis intersticial crónica de comunidades agrícolas (CINAC)Nefropatía mesoamericanaAcute kidney injury in rural workers: An environmental-stress nephropathyLesión renal aguda en trabajadores rurales: una nefropatía por estrés ambientalinfo:eu-repo/semantics/articleArtículo científicohttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_2df8fbb1Kupferman J, Ramírez-Rubio O, Amador JJ, López-Pilarte D, Wilker EH, Laws RL, et al. Acute Kidney Injury in Sugarcane Workers at Risk for Mesoamerican Nephropathy. Am J Kidney Dis. 2018 Oct;72(4):475-482. https://doi.org/10.1053/j.ajkd.2018.04.014González-Quiroz M, Pearce N, Caplin B, Nitsch D.What do epidemiological studies tell us about chronic kidney disease of undetermined cause in Meso-America? A systematic review and meta-analysis. Clin Kidney J. 2018 Aug; 11(4): 496–506. https://doi.org/10.1093/ckj/sfx136Correa-Rotter R, García-Trabanino R. Mesoamerican nephropathy: a new chronic kidney disease of hihg local relevance. Acta Médica Grupo Ángeles. 2018;16(1):S16-S22.Glaser J, Lemery J, Rajagopalan B, Diaz HF, García-Trabanino R, Taduri G et al. Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy. Clin J Am Soc Nephrol. 2016 Aug 8;11(8):1472-83. https: //doi.org/10.2215/CJN.13841215Herath C, Jayasumana C, De Silva PM, De Silva PH, Siribaddana S, De Broe ME. Kidney Diseases in Agricultural Communities: A Case Against Heat-Stress Nephropathy. Kidney International Reports. 2018;3(2):271-280. https://doi.org/10.1016/j.ekir.2017.10.006García R, Cerdas M, Madero M, Jakobsson K, Barnoya J, Crowe J, et al. Nefropatía mesoamericana: revisión breve basada en el segundo taller del Consorcio para el estudio de la Epidemia de Nefropatía en Centroamérica y México (CENCAM). Revista nefrología latinoamericana. 2017;14(1):39-45. https://doi.org/10.1016/j.nefrol.2016.11.001Wijkstrom J, Leiva R, Elinder CG, Leiva S, Trujillo Z. Trujillo L, et al. Clinical and pathological characterization of Mesoamerican nephropathy: A new kidney disease in Central America.AmJ Kidney Dis. 2013;62(5):908-918. https://doi.org/10.1053/j.ajkd.2013.05.019Kupferman J, Ramírez-Rubio O, Amador JJ, López-Pilarte D, Wilker EH, Laws RL, et al. Lesión renal aguda en trabajadores de la caña de azúcar en riesgo de nefropatía mesoamericana. Am J Kidney Dis. 2018;72(4):475-482. https://doi.org/10.1053/j.ajkd.2018.04.014Peraza S, Wesseling C, Aragon A, Leiva R, García-Trabanino RA, Torres C, et al. Decreased kidney function among agricultural workers in El Salvador. Am J Kidney Dis. 2012 Apr;59(4):531-40. https://doi.org/10.1053/j.ajkd.2011.11.039Aguilar D, Madero M. Untangling Mesoamerican Nephropathy American Journal of Kidney Diseases. National Kidney Foundation. 2018;72(4):469-471. https://doi.org/10.1053/ j.ajkd.2018.06.008Johnson R, Wesseling C, Newman L. Chronic Kidney Disease of Unknown Cause in Agricultural Communities. N Engl J Med. 2019;380:1843-1852. https://doi.org/10.1056/ NEJMra1813869Correa-Rotter R, Wesseling C, Richard J. CKD of unknown origin in Central America: the case for a Mesoamerican Nephropathy. AJ Kidney Dis. 2014;63:506-520. https://doi.org/ 10.1053/j.ajkd.2013.10.062Barahona-Lopez D, Fajardo-Leitzelar F. Mesoamerica nephropathy: consequence of climate change? Rev Nefrol Dial Traspl. 2020;40(3):273-5.Vervaet BA, D’Haese PC, Verhulst A. Environmental toxin-induced acute kidney injury. Clin Kidney Journal. 2017;10(6):747–758. https://doi.org/10.1093/ckj/sfx062Hodgson LE, Walter E , Venn RM, Galloway R, Pitsiladis Y, Sardat F, et al. Acute kidney injury associated with endurance events-is it a cause for concern? A systematic review. BMJ Open Sport Exerc Med. 2017 Jun 14;3(1):1-14 https://doi.org/10.1136/bmjsem-2015-000093Pérez-Redondo R, Bustamante J, de Paz JA. Physical activity as a modifier of renal function. Historical review. Nefrología. 2002;22(1):15-23.Furuto Y, Kawamura M, Namikawa A, Takahashi H, Shibuya Y, Mori T, et al. Non-urate transporter 1, non-glucose transporter member 9-related renal hypouricemia and acute renal failure accompanied by hyperbilirubinemia after anaerobic exercise: a case report. BMC Nephrology. 2019;20:433. https://doi.org/10.1186/s12882-019-1618-1Ejaz AA, MuW, Kang DH, Roncal C, Sautin YY, Henderson G, et al. Could Uric Acid Have a Role in Acute Renal Failure? CJASN. 2007;2(1):16-21. https://doi.org/10.2215/CJN.00350106Ejaz AA, Johnson RJ, Shimada M, Mohandas R, Alquadan KF, Beaver TM, et al. The Role of Uric Acid in Acute Kidney Injury. Nephron. 2019;142(4):275–283. https://doi.org/10.1159/ 000499939Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and chronic kidney disease: an enigma yet to be solved. Renal Failure. 2014 Oct;36(9):1351-9. https://doi.org/ 10.3109/0886022X.2014.947516Beker B, Cervellera C, De Vito A, Musso CG. Human Physiology in Extreme Heat and Cold. Int Arch Clin Physiol. 2018;1(1). https://doi.org/10.23937/iacph-2017/1710001Ajayi SO, Raji R, Michael QS, Adewole D, Akande T, Abiola B, et al. Exposure to Agrochemicals and Markers of Kidney Damage among Farmers in Rural Communities in Southwestern Nigeria. West Afr J Med. 2021 Jan;38(1):48-53.Sato Y, Takahashi M, Yanagita M. Pathophysiology of AKI to CKD Progression. Semin Nephrol. 2020 Mar;40(2):206-215. https://doi.org/10.1016/j.semnephrol.2020.01.011Hsu R, Hsu C. The role of acute kidney injury in chronic kidney disease. Semin Nephrol. 2016 Jul;36(4):283–292. https://doi.org/10.1016/j.semnephrol.2016.05.005Dousdampanis P, Trigka K, Musso CG, Fourtounas C. Hyperuricemia and Chronic Kidney Disease: An Enigma Yet to Be Solved. Ren Fail. 2014;36(9):1351–1359. https://doi.org/10.3109/ 0886022X.2014.947516Giordano C, Karasik O, King-Morris K, Asmar A. Uric Acid as a Marker of Kidney Disease: Review of the Current Literature. Dis Markers. 2015 May;27: 382918. https://doi.org/10.1155/ 2015/382918Kamiyama M, Kataoka H, Moriyama T, Mochizuki T, Nitta K. Hyperuricemia as a Predictor of Progression of Chronic Kidney Disease: A Matched Cohort Analysis. Int J Clin Med. 2017;8(3):178-197. https://doi.org/10.4236/ijcm.2017.83018Paula Santos U, Zanetta DM, Terra-Filho M, Burdmann EA. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int. 2015;87(4):792–799. https://doi.org/ 10.1038/ki.2014.306García-Trabanino R, Jarquín E, Wesseling C, Johnson RJ, González-Quiroz M, Weiss I, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador – A cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res. 2015;142:746-155. https://doi.org/10.1016/j.envres.2015.07.007Wesseling C, Aragón A, González M,Weiss I, Glaser J, Bobadilla N, et al. Kidney function in sugarcane cutters in Nicaragua - A longitudinal study of workers at risk of Mesoamerican nephropathy. Environ Res. 2016;147:125-132. https://doi.org/10.1016/j.envres.2016.02.002Herat H C, Jayasumana C, De Silva M, De Silva C, Siribaddana S, De Broe M. Kidney diseases in agricultural communities: A case against heat-stress nephropathy. 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Acute kidney injury in rural workers: An environmental-stress nephropathy

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