Clinical Characteristics of Chronic Kidney Disease of Nontraditional Causes in Salvadoran Farming Communities
Clinical Characteristics of Chronic Kidney Disease of Nontraditional Causes in Salvadoran Farming Communities
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DOI：
10.37757/mr2014.v16.n2.7
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发表时间：
2014-04-01
期刊：
影响因子：
2.1
通讯作者：
Aparicio, Claudia E.
中科院分区：
文献类型：
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作者：
Herrera, Raul;Orantes, Carlos M.;Aparicio, Claudia E.
引言慢性肾脏疾病是萨尔瓦多的一个严重健康问题。自1990年代以来，与传统风险因素无关的病例有所增加。它是18岁以上男性死亡的第二大原因。2009年，这是男性住院死亡的第一位原因，女性住院死亡的第五位原因。这种疾病还没有被彻底studied. ObjectiveCharacterize临床表现（包括肾外）和病理生理学的慢性肾脏疾病的非传统原因，在萨尔瓦多农业community.METHODS的描述性临床研究进行了46名参与者（36名男性，10名女性），确定通过慢性肾脏疾病人群筛查的5018人。入选标准为年龄18-59岁; 2、3a和3b期慢性肾脏疾病，或3a和3b期慢性肾脏疾病伴糖尿病或高血压且无蛋白尿;眼底镜检查正常;肾脏超声检查无结构异常; HIV阴性。检查包括社会决定因素;心理评估;器官和系统的临床检查;血液和尿液中的血液学和生化参数;尿沉渣分析;肾损伤标志物;肾小球和肾小管功能;以及肝脏、胰腺和肺功能。结果慢性肾脏病患者的临床分期分布为：2期（32.6%），3a期（23.9%），3b期（43.5%）。贫穷是所观察到的主要社会决定因素。危险因素流行率：农业化学品接触（95.7%），农业工作（78.3%），男性（78.3%），工作时大量出汗（76.3%），疟疾（43.5%），非甾体抗炎药使用（41.3%），高血压（36.9%），糖尿病（4.3%）。全身症状：关节痛（54.3%）、乏力（52.2%）、痉挛（45.7%）、晕厥（30.4%）。肾脏症状：夜尿（65.2%）、排尿困难（39.1%）、泡沫尿（63%）。肾损害标志物：大量白蛋白尿（80.4%）、β 2微球蛋白（78.2%）、NGAL（26.1%）。肾功能：高镁尿（100%）、高磷酸盐尿（50%）、高钠尿（45.7%）、高钾尿（23.9%）、高钙尿（17.4%）、电解质多尿（43.5%）、代谢紊乱（45.7%）、低钠血症（47.8%）、低钙血症（39.1%）、低钾血症（30.4%）、低镁血症（19.6%）。影像学：超声显示脂肪肝（93.5%），血管多普勒显示胫动脉损害（66.7%）。神经系统症状：腱反射异常（45.6%），巴宾斯基征和肌阵挛（6.5%），感音神经性聋（56.5%）。虽然男性农业工人占主导地位，但妇女和青少年也受到影响。研究结果支持一个假设的多因素病因与肾毒性的环境因素发挥了关键作用。
INTRODUCTION 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.OBJECTIVE Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities.METHODS 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.RESULTS 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: macro-albuminuria (80.4%), beta 2 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%).CONCLUSIONS 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.