THE MESOAMERICAN NEPHROPATHY: A REGIONAL EPIDEMIC OF CHRONIC KIDNEY DISEASE?
An article by Vito M. Campese
In the history of humanity, the struggle for survival has been an ongoing issue as human beings face epidemics from different sources, environmental adversities and exposure to toxins.
The kidneys receive approximately one fi fth of blood volume per unit time and, given their secretory and excretory functions, they are commonly victimized by environmental toxins or drugs ingested for therapeutic or recreational reasons. In recent years, there has been a substantial rise in kidney diseases caused by drugs, such as heroin, cocaine and amphetamines, and a surge in kidney diseases induced by medications (non-steroidal anti-infl ammatory agents, antibiotics, lithium, platinum, immunosuppressive agents, to mention a few) or diagnostic agents (such as, contrast agents).
On occasion, epidemic or endemic forms of kidney diseases caused by environmental toxins have been described. A typical example is the so-called Balkan nephropathy. This is an endemic form of tubule-interstitial nephropathy identifi ed among persons living in rural areas of the Danube River in Serbia, Bulgaria, Croatia, Romania and Bosnia. After approximately 50 years of epidemiologic and clinical studies, it was determined that aristolochic acid, a contaminant of the wheat fl our, was the likely cause of this nephropathy. This toxin is also the cause of Chinese herb nephropathy, fi rst described in a cluster of cases in Belgium. Mesoamerican Nephropathy (MeN) caused by aristolochic acid has been described in multiple regions of the world, particularly in Asia, in association with ingestion of contaminated food products, beverages and herbal remedies containing aristolochic acid. More recently, several epidemiological studies have described an excess of MeN among younger adult males in the geographic region that includes Southeastern Mexico, Guatemala, Belize, El Salvador, Honduras, Nicaragua, Costa Rica and Panama.
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