Mesoamerican Nephropathy or Global Warming Nephropathy?
Mesoamerican Nephropathy or Global Warming Nephropathy?
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中美洲肾病还是全球变暖肾病？
DOI：
10.1159/000441265
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发表时间：
2016
影响因子：
3
通讯作者：
Johnson,RichardJ
中科院分区：
文献类型：
--
作者：
Roncal-Jimenez,CarlosA;García-Trabanino,Ramon;Wesseling,Catharina;Johnson,RichardJ
背景：在中美洲的太平洋沿岸沿着出现了一种病因不明的慢性肾脏病（CKD）流行病。这种疾病主要影响在户外手工工作的男子，受影响的主要群体是甘蔗工人。该疾病表现为血清肌酐无症状升高，数年后进展为终末期肾病。肾活检显示慢性肾小管间质疾病。虽然原因尚不清楚，但最近的研究表明，这是由炎热气候中的反复脱水引起的。潜在的机制包括高渗透压的发展，近端小管中的醛糖还原酶-果糖激酶途径活化，导致局部损伤和炎症，以及肾损伤可能是重复的尿酸尿和尿酸盐晶体形成的结果，这是生成和尿浓度增加的结果，类似于慢性肿瘤溶解综合征。据推测，由于全球变暖的影响，该流行病正在增加。总结：CKD的流行已导致中美洲超过20，000人死亡。原因不明，但似乎是由于反复脱水。损伤的潜在机制是肾损害的结果，反复高渗和/或损伤肾小管反复发作的uricosuria.Key消息：慢性肾脏病的流行病在中美洲可能是由于慢性复发性脱水的后果，全球变暖和工作条件。这一实体可能是归因于气候变化和温室效应的首批主要疾病之一。
Background:An epidemic of chronic kidney disease (CKD) of unknown cause has emerged along the Pacific Coast of Central America. The disease primarily affects men working manually outdoors, and the major group affected is sugarcane workers. The disease presents with an asymptomatic rise in serum creatinine that progresses to end-stage renal disease over several years. Renal biopsies show chronic tubulointerstitial disease. While the cause remains unknown, recent studies suggest that it is driven by recurrent dehydration in the hot climate. Potential mechanisms include the development of hyperosmolarity with the activation of the aldose reductase-fructokinase pathway in the proximal tubule leading to local injury and inflammation, and the possibility that renal injury may be the consequence of repeated uricosuria and urate crystal formation as a consequence of both increased generation and urinary concentration, similar to a chronic tumor lysis syndrome. The epidemic is postulated to be increasing due to the effects of global warming.Summary:An epidemic of CKD has led to the death of more than 20,000 lives in Central America. The cause is unknown, but appears to be due to recurrent dehydration. Potential mechanisms for injury are renal damage as a consequence of recurrent hyperosmolarity and/or injury to the tubules from repeated episodes of uricosuria.Key Messages:The epidemic of CKD in Mesoamerica may be due to chronic recurrent dehydration as a consequence of global warming and working conditions. This entity may be one of the first major diseases attributed to climate change and the greenhouse effect.