General Information:

• There is a growing incidence of chronic kidney disease (CKD) in Central America referred to as Mesoamerican Nephropathy
• Patients tend to be young (30-50 years old), male, agricultural workers, and do not have a history of diabetes, hypertension, or obesity
• Etiology remains unconfirmed but is likely multifactorial with contributors including: repeated dehydration, excessive NSAID use, toxins from sugarcane derived alcohol, and mild Leptospirosis infection.

Area of the world affected:

• Highest prevalence in El Salvador and Nicaragua
• Lower prevalence in Costa Rica and Guatemala

Relevance to the US physician:

• Immigrants with Mesoamerican Nephropathy may present to the ED with acute on chronic kidney disease
• Treatment guidelines are the same as for other CKD etiologies
• Council patients on proper hydration during exertion, limiting NSAID use, and avoiding homemade alcohol consumption

Bottom Line:

• Mesoamerican Nephropathy should be considered in Central American immigrants presenting to the ED with clinical and laboratory signs of CKD but without traditional risk factors.

University of Maryland Section of Global Emergency Health

Author: Emilie J.B. Calvello, MD, MPH & Alex Skog

References

Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis. 2014 Mar;63(3):506–20.